CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0-snapshot1 - STU 2.1 prepublication draft United States of America flag

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0-snapshot1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

Resource Profile: C4BBExplanationOfBenefitProfessionalNonClinicianBasis - Detailed Descriptions

Page standards status: Trial-use

Definitions for the C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis resource profile.

Guidance on how to interpret the contents of this table can be found here

0. ExplanationOfBenefit
InvariantsEOB-prof-all-transportation-supportinginfo-linked-to-line: Professional EOB: SupportingInfo repetitions with with transportation category code must be referred to by one or more repetitions of item.informationSequence (supportingInfo.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTransportationServiceCategories')).sequence.subsetOf(%context.item.informationSequence))
EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. (type.coding.where(code = 'vision' and system='http://terminology.hl7.org/CodeSystem/claim-type').exists() or item.productOrService.coding.where(code = 'not-applicable' and system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists().not())
2. ExplanationOfBenefit.type
BindingThe codes SHALL be taken from C4BB Professional And Non Clinician Claim Type Value Set
(required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBProfessionalAndNonClinicianClaimType)
4. ExplanationOfBenefit.careTeam
InvariantsEOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner (( role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner) ))
6. ExplanationOfBenefit.careTeam.role
Control1..?
BindingThe codes SHALL be taken from C4BB Claim Professional And Non Clinician Care Team Role Value Set
(required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianCareTeamRole)
8. ExplanationOfBenefit.careTeam.qualification
BindingThe codes SHALL be taken from Healthcare Provider Taxonomy .
(required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
Must Supporttrue
10. ExplanationOfBenefit.supportingInfo
SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ category
  • 12. ExplanationOfBenefit.supportingInfo:clmrecvddate
    Slice Nameclmrecvddate
    ShortClaim received date
    Comments

    The date the claim was received by the payer (88)

    Control0..1
    Must Supporttrue
    14. ExplanationOfBenefit.supportingInfo:clmrecvddate.category
    Must Supporttrue
    Pattern Value{
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
        "code" : "clmrecvddate"
      }]
    }
    16. ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x]
    Control1..?
    Typedate
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    18. ExplanationOfBenefit.supportingInfo:servicefacility
    Slice Nameservicefacility
    ShortService facility
    Comments

    Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rndering Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA. If the service facility is not assigned an NPI, this data element will not be populated. Reference CMS 1500 element 32a (97, 170, 176)

    Control0..1
    Must Supporttrue
    20. ExplanationOfBenefit.supportingInfo:servicefacility.category
    Must Supporttrue
    Pattern Value{
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
        "code" : "servicefacility"
      }]
    }
    22. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]
    Control1..?
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 24. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]:valueReference
      Slice NamevalueReference
      Control1..1
      TypeReference(C4BB Organization)
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Must Supporttrue
      26. ExplanationOfBenefit.supportingInfo:medicalrecordnumber
      Slice Namemedicalrecordnumber
      ShortMedical record number
      Comments

      Provider submitted medical record number that can be included on the claim. (109)

      Control0..1
      Must Supporttrue
      28. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.category
      Pattern Value{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
          "code" : "medicalrecordnumber"
        }]
      }
      30. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]
      Control1..?
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • type @ $this
      • 32. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]:valueString
        Slice NamevalueString
        Control1..1
        Typestring
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        34. ExplanationOfBenefit.supportingInfo:patientaccountnumber
        Slice Namepatientaccountnumber
        ShortPatient account number
        Comments

        Provider assigned patient account number that can be included on the claim. (109)

        Control0..1
        Must Supporttrue
        36. ExplanationOfBenefit.supportingInfo:patientaccountnumber.category
        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
            "code" : "patientaccountnumber"
          }]
        }
        38. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]
        Control1..?
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • type @ $this
        • 40. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]:valueString
          Slice NamevalueString
          Control1..1
          Typestring
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          42. ExplanationOfBenefit.supportingInfo:patientweight
          Slice Namepatientweight
          Control0..*
          Must Supporttrue
          44. ExplanationOfBenefit.supportingInfo:patientweight.category
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code" : "patientweight"
            }]
          }
          46. ExplanationOfBenefit.supportingInfo:patientweight.code
          Control0..0
          48. ExplanationOfBenefit.supportingInfo:patientweight.timing[x]
          Control0..0
          50. ExplanationOfBenefit.supportingInfo:patientweight.value[x]
          Control1..?
          TypeQuantity
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          52. ExplanationOfBenefit.supportingInfo:patientweight.value[x].value
          Control1..?
          54. ExplanationOfBenefit.supportingInfo:patientweight.value[x].unit
          Pattern Value[lb_av]
          56. ExplanationOfBenefit.supportingInfo:patientweight.value[x].system
          Pattern Valuehttp://unitsofmeasure.org
          58. ExplanationOfBenefit.supportingInfo:ambulancetransportreason
          Slice Nameambulancetransportreason
          Control0..*
          Must Supporttrue
          60. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.category
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code" : "ambulancetransportreason"
            }]
          }
          62. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.code
          Control0..0
          64. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.timing[x]
          Control0..0
          66. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.reason
          Control1..?
          BindingThe codes SHALL be taken from C4BB Ambulance Transport Reasons Value Set
          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAmbulanceTransportReasonCodes)
          68. ExplanationOfBenefit.supportingInfo:transportationdistance
          Slice Nametransportationdistance
          Control0..*
          Must Supporttrue
          70. ExplanationOfBenefit.supportingInfo:transportationdistance.category
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code" : "transportationdistance"
            }]
          }
          72. ExplanationOfBenefit.supportingInfo:transportationdistance.code
          Control0..0
          74. ExplanationOfBenefit.supportingInfo:transportationdistance.timing[x]
          Control0..0
          76. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]
          Control1..?
          TypeQuantity
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          78. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].value
          Control1..?
          80. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].unit
          Pattern Value[mi_i]
          82. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].system
          Pattern Valuehttp://unitsofmeasure.org
          84. ExplanationOfBenefit.supportingInfo:roudtrippurpose
          Slice Nameroudtrippurpose
          Control0..*
          Must Supporttrue
          86. ExplanationOfBenefit.supportingInfo:roudtrippurpose.category
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code" : "roudtrippurpose"
            }]
          }
          88. ExplanationOfBenefit.supportingInfo:roudtrippurpose.code
          Control0..0
          90. ExplanationOfBenefit.supportingInfo:roudtrippurpose.timing[x]
          Control0..0
          92. ExplanationOfBenefit.supportingInfo:roudtrippurpose.value[x]
          Control1..?
          Typestring
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          94. ExplanationOfBenefit.supportingInfo:stretcherpurpose
          Slice Namestretcherpurpose
          Control0..*
          Must Supporttrue
          96. ExplanationOfBenefit.supportingInfo:stretcherpurpose.category
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code" : "stretcherpurpose"
            }]
          }
          98. ExplanationOfBenefit.supportingInfo:stretcherpurpose.code
          Control0..0
          100. ExplanationOfBenefit.supportingInfo:stretcherpurpose.timing[x]
          Control0..0
          102. ExplanationOfBenefit.supportingInfo:stretcherpurpose.value[x]
          Control1..?
          Typestring
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          104. ExplanationOfBenefit.supportingInfo:pickuplocation
          Slice Namepickuplocation
          Control0..*
          Must Supporttrue
          106. ExplanationOfBenefit.supportingInfo:pickuplocation.category
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code" : "pickuplocation"
            }]
          }
          108. ExplanationOfBenefit.supportingInfo:pickuplocation.code
          Control0..0
          110. ExplanationOfBenefit.supportingInfo:pickuplocation.timing[x]
          Control0..0
          112. ExplanationOfBenefit.supportingInfo:pickuplocation.value[x]
          Control1..?
          Typestring
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          114. ExplanationOfBenefit.supportingInfo:dropofflocation
          Slice Namedropofflocation
          Control0..*
          Must Supporttrue
          116. ExplanationOfBenefit.supportingInfo:dropofflocation.category
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code" : "dropofflocation"
            }]
          }
          118. ExplanationOfBenefit.supportingInfo:dropofflocation.code
          Control0..0
          120. ExplanationOfBenefit.supportingInfo:dropofflocation.timing[x]
          Control0..0
          122. ExplanationOfBenefit.supportingInfo:dropofflocation.value[x]
          Control1..?
          Typestring
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          124. ExplanationOfBenefit.diagnosis
          Comments

          Diagnosis codes describe an individual's disease or medical condition. (6, 7, 8, 21, 22, 23, 30)

          Control1..?
          Must Supporttrue
          126. ExplanationOfBenefit.diagnosis.sequence
          Comments

          Diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. client app implementations should not assign any significance to the sequence values. client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.

          128. ExplanationOfBenefit.diagnosis.diagnosis[x]
          BindingThe codes SHALL be taken from Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set
          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CDCICD910CMDiagnosisCodes)
          TypeCodeableConcept, Reference(Condition)
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Must Supporttrue
          130. ExplanationOfBenefit.diagnosis.type
          Comments

          Indicates if the professional and non-clinician diagnosis is principal or secondary (21, 22, 23)

          Control1..1
          BindingThe codes SHALL be taken from C4BB Claim Professional And Non Clinician Diagnosis Type Value Set
          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianDiagnosisType)
          Must Supporttrue
          132. ExplanationOfBenefit.item
          134. ExplanationOfBenefit.item.productOrService
          Comments

          Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40)

          BindingThe codes SHALL be taken from Procedure Codes - AMA CPT - CMS HCPCS Value Set
          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSProcedureCodes)
          Must Supporttrue
          136. ExplanationOfBenefit.item.modifier
          Comments

          Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41)

          BindingThe codes SHALL be taken from Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set
          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers)
          Must Supporttrue
          138. ExplanationOfBenefit.item.serviced[x]
          Comments

          Date services began/ended. Located on CMS 1500 (Form Locator 24A) (118)

          Control1..?
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          140. ExplanationOfBenefit.item.location[x]
          Comments

          Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed. (46)

          Control1..?
          BindingThe codes SHALL be taken from CMS Place of Service Codes (POS) Value Set
          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CMSPlaceofServiceCodes)
          TypeCodeableConcept, Address, Reference(Location)
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Must Supporttrue
          142. ExplanationOfBenefit.item.quantity
          Comments

          The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code or CPT procedure code, submitted by the provider. (42)

          144. ExplanationOfBenefit.item.adjudication
          Control1..?
          Must Supporttrue
          SlicingThis element introduces a set of slices on ExplanationOfBenefit.item.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • pattern @ category
          • 146. ExplanationOfBenefit.item.adjudication.category
            BindingUnless not suitable, these codes SHALL be taken from C4BB Adjudication Category Discriminator Value Set
            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
            148. ExplanationOfBenefit.item.adjudication:adjustmentreason
            Slice Nameadjustmentreason
            ShortReason codes used to interpret the Non-Covered Amount (92)
            Comments

            Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)

            Control0..1
            Must Supporttrue
            150. ExplanationOfBenefit.item.adjudication:adjustmentreason.category
            Pattern Value{
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                "code" : "adjustmentreason"
              }]
            }
            152. ExplanationOfBenefit.item.adjudication:adjustmentreason.reason
            Control1..?
            BindingThe codes SHALL be taken from X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set
            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes)
            Must Supporttrue
            154. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus
            Slice Namebenefitpaymentstatus
            ShortIndicates the in network or out of network payment status of the claim. (142)
            Comments

            Indicates the in network or out of network payment status of the claim. (142)

            Control1..1
            Must Supporttrue
            156. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.category
            Pattern Value{
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                "code" : "benefitpaymentstatus"
              }]
            }
            158. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.reason
            Control1..?
            BindingThe codes SHALL be taken from C4BB Payer Benefit Payment Status Value Set
            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerBenefitPaymentStatus)
            Must Supporttrue
            160. ExplanationOfBenefit.item.adjudication:allowedunits
            Slice Nameallowedunits
            ShortThe quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)
            Comments

            The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)

            Control0..1
            Must Supporttrue
            162. ExplanationOfBenefit.item.adjudication:allowedunits.category
            Pattern Value{
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                "code" : "allowedunits"
              }]
            }
            164. ExplanationOfBenefit.adjudication
            TypeBackboneElement
            Must Supporttrue
            SlicingThis element introduces a set of slices on ExplanationOfBenefit.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ category
            • 166. ExplanationOfBenefit.adjudication.category
              BindingUnless not suitable, these codes SHALL be taken from C4BB Adjudication Category Discriminator Value Set
              (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
              Must Supporttrue
              168. ExplanationOfBenefit.adjudication:billingnetworkstatus
              Slice Namebillingnetworkstatus
              ShortBilling provider networking status
              Comments

              Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101)

              Control0..1
              Must Supporttrue
              170. ExplanationOfBenefit.adjudication:billingnetworkstatus.category
              Pattern Value{
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                  "code" : "billingnetworkstatus"
                }]
              }
              172. ExplanationOfBenefit.adjudication:billingnetworkstatus.reason
              Control1..?
              BindingThe codes SHALL be taken from C4BB Payer Provider Network Status Value Set
              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus)
              Must Supporttrue
              174. ExplanationOfBenefit.adjudication:renderingnetworkstatus
              Slice Namerenderingnetworkstatus
              ShortRendering provider networking status
              Comments

              Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission. (101)

              Control0..1
              Must Supporttrue
              176. ExplanationOfBenefit.adjudication:renderingnetworkstatus.category
              Pattern Value{
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                  "code" : "renderingnetworkstatus"
                }]
              }
              178. ExplanationOfBenefit.adjudication:renderingnetworkstatus.reason
              Control1..?
              BindingThe codes SHALL be taken from C4BB Payer Provider Network Status Value Set
              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus)
              Must Supporttrue

              Guidance on how to interpret the contents of this table can be found here

              0. ExplanationOfBenefit
              Definition

              This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.

              ShortExplanation of Benefit resource
              Control0..*
              Is Modifierfalse
              Summaryfalse
              Alternate NamesEOB
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
              dom-6: A resource should have narrative for robust management (text.`div`.exists())
              EOB-prof-all-transportation-supportinginfo-linked-to-line: Professional EOB: SupportingInfo repetitions with with transportation category code must be referred to by one or more repetitions of item.informationSequence (supportingInfo.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTransportationServiceCategories')).sequence.subsetOf(%context.item.informationSequence))
              EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. (type.coding.where(code = 'vision' and system='http://terminology.hl7.org/CodeSystem/claim-type').exists() or item.productOrService.coding.where(code = 'not-applicable' and system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists().not())
              2. ExplanationOfBenefit.meta
              Definition

              The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

              ShortMetadata about the resource
              Control10..1
              TypeMeta
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              4. ExplanationOfBenefit.meta.lastUpdated
              Definition

              When the resource last changed - e.g. when the version changed.

              ShortWhen the resource version last changed
              Comments

              Defines the date the Resource was created or updated, whichever comes last (163). Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last


              This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

              Control10..1
              Typeinstant
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              6. ExplanationOfBenefit.meta.profile
              Definition

              A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

              ShortProfiles this resource claims to conform to
              Comments

              meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest. CPCDS data element (190)


              It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

              Control10..*
              Typecanonical(StructureDefinition)
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              8. ExplanationOfBenefit.implicitRules
              Definition

              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

              ShortA set of rules under which this content was created
              Comments

              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

              Control0..1
              Typeuri
              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              10. ExplanationOfBenefit.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
              Summaryfalse
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              12. ExplanationOfBenefit.identifier
              Definition

              A unique identifier assigned to this explanation of benefit.

              ShortBusiness Identifier for the resource
              Comments

              Identifier assigned by a payer for a claim received from a provider or subscriber. It is not the same identifier as that assigned by a provider. (35)

              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control10..*
              TypeIdentifier
              Is Modifierfalse
              Summaryfalse
              Requirements

              Allows EOBs to be distinguished and referenced.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on ExplanationOfBenefit.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • pattern @ type
              • 14. ExplanationOfBenefit.identifier.use
                Definition

                The purpose of this identifier.

                Shortusual | official | temp | secondary | old (If known)
                Comments

                Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                Control0..1
                BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                Identifies the purpose for this identifier, if known .

                Typecode
                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                16. ExplanationOfBenefit.identifier:uniqueclaimid
                Slice Nameuniqueclaimid
                Definition

                A unique identifier assigned to this explanation of benefit.

                ShortUnique Claim IdentifierBusiness Identifier for the resource
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control10..1*
                TypeIdentifier
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Allows EOBs to be distinguished and referenced.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                18. ExplanationOfBenefit.identifier:uniqueclaimid.use
                Definition

                The purpose of this identifier.

                Shortusual | official | temp | secondary | old (If known)
                Comments

                Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                Control0..1
                BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                Identifies the purpose for this identifier, if known .

                Typecode
                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                20. ExplanationOfBenefit.identifier:uniqueclaimid.type
                Definition

                A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                ShortDescription of identifier
                Comments

                This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                Control10..1
                BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
                (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Requirements

                Allows users to make use of identifiers when the identifier system is not known.

                Pattern Value{
                  "coding" : [{
                    "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                    "code" : "uc"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                22. ExplanationOfBenefit.identifier:uniqueclaimid.value
                Definition

                The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                ShortUnique Claim IdentifierThe value that is unique
                Comments

                If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                Control10..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Example<br/><b>General</b>:123456
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                24. ExplanationOfBenefit.status
                Definition

                The status of the resource instance.

                Shortactive | cancelled | draft | entered-in-error
                Comments

                Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required


                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                Control1..1
                BindingThe codes SHALL be taken from ExplanationOfBenefitStatushttp://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1
                (required to http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1)

                A code specifying the state of the resource instance.

                Typecode
                Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Requirements

                Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                26. ExplanationOfBenefit.type
                Definition

                The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

                ShortCategory or discipline
                Comments

                Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.) (16). Defines the Claims profiles. Values from Claim Type Codes are required; a data absent reason is not allowed


                The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.

                Control1..1
                BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from C4BB Professional And Non Clinician Claim Type Value Sethttp://hl7.org/fhir/ValueSet/claim-type
                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBProfessionalAndNonClinicianClaimType)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Claim type determine the general sets of business rules applied for information requirements and adjudication.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                28. ExplanationOfBenefit.use
                Definition

                A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

                Shortclaim | preauthorization | predetermination
                Comments

                Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations

                Control1..1
                BindingThe codes SHALL be taken from Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1
                (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

                Complete, proposed, exploratory, other.

                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Requirements

                This element is required to understand the nature of the request for adjudication.

                Pattern Valueclaim
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                30. ExplanationOfBenefit.patient
                Definition

                The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.

                ShortThe recipient of the products and services
                Comments

                Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided. (1). The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudication. Additional required path:EOB.insurance.coverage(Coverage).beneficiary(Patient).identifier

                Control1..1
                TypeReference(C4BB Patient, Patient)
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                32. ExplanationOfBenefit.billablePeriod
                Definition

                The period for which charges are being submitted.

                ShortRelevant time frame for the claim
                Comments

                Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified.

                Control10..1
                TypePeriod
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                34. ExplanationOfBenefit.billablePeriod.start
                Definition

                The start of the period. The boundary is inclusive.

                ShortStarting time with inclusive boundary
                Comments

                The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177)


                If the low element is missing, the meaning is that the low boundary is not known.

                Control10..1
                This element is affected by the following invariants: per-1
                TypedateTime
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                36. ExplanationOfBenefit.created
                Definition

                The date this resource was created.

                ShortResponse creation date
                Comments

                Date the claim was adjudicated (179)


                This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

                Control1..1
                TypedateTime
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Need to record a timestamp for use by both the recipient and the issuer.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                38. ExplanationOfBenefit.insurer
                Definition

                The party responsible for authorization, adjudication and reimbursement.

                ShortParty responsible for reimbursement
                Comments

                Code of the payer responsible for the claim (2, 5). Same as insurance.coverage.organization. Party responsible for reimbursing the provider

                Control1..1
                TypeReference(C4BB Organization, Organization)
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                40. ExplanationOfBenefit.provider
                Definition

                The provider which is responsible for the claim, predetermination or preauthorization.

                ShortParty responsible for the claim
                Comments

                The identifier assigned to the Billing Provider. (94)


                Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

                Control1..1
                TypeReference(C4BB Organization, C4BB Practitioner, Practitioner, PractitionerRole, Organization)
                Is Modifierfalse
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                42. ExplanationOfBenefit.related
                Definition

                Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

                ShortPrior or corollary claims
                Comments

                If the current claim represents a claim that has been adjusted and was given a prior claim number, this field represents the prior claim number. If the current claim has been adjusted; i.e., replaced by or merged to another claim number, this data element represents that new number.(111, 112)


                For example, for the original treatment and follow-up exams.

                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                For workplace or other accidents it is common to relate separate claims arising from the same event.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                44. ExplanationOfBenefit.related.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                46. ExplanationOfBenefit.related.relationship
                Definition

                A code to convey how the claims are related.

                ShortHow the reference claim is related
                Comments

                For example, prior claim or umbrella.

                Control10..1
                BindingThe codes SHALL be taken from For example codes, see C4BB Related Claim Relationship Codes Value Sethttp://hl7.org/fhir/ValueSet/related-claim-relationship
                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Some insurers need a declaration of the type of relationship.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                48. ExplanationOfBenefit.related.reference
                Definition

                An alternate organizational reference to the case or file to which this particular claim pertains.

                ShortFile or case reference
                Comments

                For example, Property/Casualty insurer claim number or Workers Compensation case number.

                Control10..1
                TypeIdentifier
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                50. ExplanationOfBenefit.payee
                Definition

                The party to be reimbursed for cost of the products and services according to the terms of the policy.

                ShortRecipient of benefits payable
                Comments

                Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead.

                Control0..1
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required (type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists())
                52. ExplanationOfBenefit.payee.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                54. ExplanationOfBenefit.payee.type
                Definition

                Type of Party to be reimbursed: Subscriber, provider, other.

                ShortCategory of recipient
                Comments

                Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120)

                Control10..1
                BindingThe codes SHALL be taken from For example codes, see C4BB Payee Type Value Sethttp://hl7.org/fhir/ValueSet/payeetype
                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                56. ExplanationOfBenefit.payee.party
                Definition

                Reference to the individual or organization to whom any payment will be made.

                ShortRecipient reference
                Comments

                Recipient reference (121)


                Not required if the payee is 'subscriber' or 'provider'.

                Control0..1
                TypeReference(C4BB Organization, C4BB Patient, C4BB Practitioner, C4BB RelatedPerson, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson)
                Is Modifierfalse
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summaryfalse
                Requirements

                Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                58. ExplanationOfBenefit.outcome
                Definition

                The outcome of the claim, predetermination, or preauthorization processing.

                Shortqueued | complete | error | partial
                Comments

                Expected value is complete


                The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).

                Control1..1
                BindingThe codes SHALL be taken from ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1
                (required to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1)

                The result of the claim processing.

                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Requirements

                To advise the requestor of an overall processing outcome.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                60. ExplanationOfBenefit.careTeam
                Definition

                The members of the team who provided the products and services.

                ShortCare Team members
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Common to identify the responsible and supporting practitioners.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner (( role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner) ))
                62. ExplanationOfBenefit.careTeam.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                64. ExplanationOfBenefit.careTeam.sequence
                Definition

                A number to uniquely identify care team entries.

                ShortOrder of care team
                Comments

                careTeam.sequence values uniquely identify careTeam members. They do not necessarily indicate any order in which the patient was seen by the careTeam or identify any level of significance of the careTeam to the patient, etc. Client app implementations should not assign any significance to the sequence values

                Control1..1
                TypepositiveInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Requirements

                Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                66. ExplanationOfBenefit.careTeam.provider
                Definition

                Member of the team who provided the product or service.

                ShortPractitioner or organization
                Comments

                The identifier assigned to the care team. (varies depending on the profile)

                Control1..1
                TypeReference(C4BB Organization, C4BB Practitioner, Practitioner, PractitionerRole, Organization)
                Is Modifierfalse
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summaryfalse
                Requirements

                Often a regulatory requirement to specify the responsible provider.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                68. ExplanationOfBenefit.careTeam.role
                Definition

                The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

                ShortFunction within the team
                Comments

                The functional role of a provider on a claim. (165)


                Role might not be required when there is only a single provider listed.

                Control10..1
                BindingThe codes SHALL be taken from For example codes, see C4BB Claim Professional And Non Clinician Care Team Role Value Sethttp://hl7.org/fhir/ValueSet/claim-careteamrole
                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianCareTeamRole)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                When multiple parties are present it is required to distinguish the roles performed by each member.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                70. ExplanationOfBenefit.careTeam.qualification
                Definition

                The qualification of the practitioner which is applicable for this service.

                ShortPractitioner credential or specialization
                Control0..1
                BindingThe codes SHALL be taken from For example codes, see Healthcare Provider Taxonomy .http://hl7.org/fhir/ValueSet/provider-qualification
                (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Need to specify which qualification a provider is delivering the product or service under.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                72. ExplanationOfBenefit.supportingInfo
                Definition

                Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                ShortSupporting information
                Comments

                Defines data elements not available in the base EOB resource


                Often there are multiple jurisdiction specific valuesets which are required.

                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • pattern @ category
                • 74. ExplanationOfBenefit.supportingInfo.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  76. ExplanationOfBenefit.supportingInfo.sequence
                  Definition

                  A number to uniquely identify supporting information entries.

                  ShortInformation instance identifier
                  Comments

                  Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  78. ExplanationOfBenefit.supportingInfo.category
                  Definition

                  The general class of the information supplied: information; exception; accident, employment; onset, etc.

                  ShortClassification of the supplied information
                  Comments

                  This may contain a category for the local bill type codes.

                  Control1..1
                  BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                  (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  80. ExplanationOfBenefit.supportingInfo:clmrecvddate
                  Slice Nameclmrecvddate
                  Definition

                  Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                  ShortClaim received dateSupporting information
                  Comments

                  The date the claim was received by the payer (88)


                  Often there are multiple jurisdiction specific valuesets which are required.

                  Control0..1*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  82. ExplanationOfBenefit.supportingInfo:clmrecvddate.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  84. ExplanationOfBenefit.supportingInfo:clmrecvddate.sequence
                  Definition

                  A number to uniquely identify supporting information entries.

                  ShortInformation instance identifier
                  Comments

                  Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  86. ExplanationOfBenefit.supportingInfo:clmrecvddate.category
                  Definition

                  The general class of the information supplied: information; exception; accident, employment; onset, etc.

                  ShortClassification of the supplied information
                  Comments

                  This may contain a category for the local bill type codes.

                  Control1..1
                  BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                  (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                  Pattern Value{
                    "coding" : [{
                      "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                      "code" : "clmrecvddate"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  88. ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x]
                  Definition

                  The date when or period to which this information refers.

                  ShortWhen it occurred
                  Control10..1
                  Typedate, Period
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  90. ExplanationOfBenefit.supportingInfo:servicefacility
                  Slice Nameservicefacility
                  Definition

                  Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                  ShortService facilitySupporting information
                  Comments

                  Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rndering Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA. If the service facility is not assigned an NPI, this data element will not be populated. Reference CMS 1500 element 32a (97, 170, 176)


                  Often there are multiple jurisdiction specific valuesets which are required.

                  Control0..1*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  92. ExplanationOfBenefit.supportingInfo:servicefacility.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  94. ExplanationOfBenefit.supportingInfo:servicefacility.sequence
                  Definition

                  A number to uniquely identify supporting information entries.

                  ShortInformation instance identifier
                  Comments

                  Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  96. ExplanationOfBenefit.supportingInfo:servicefacility.category
                  Definition

                  The general class of the information supplied: information; exception; accident, employment; onset, etc.

                  ShortClassification of the supplied information
                  Comments

                  This may contain a category for the local bill type codes.

                  Control1..1
                  BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                  (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                  Pattern Value{
                    "coding" : [{
                      "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                      "code" : "servicefacility"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  98. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]
                  Definition

                  Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                  ShortData to be provided
                  Comments

                  Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                  Control10..1
                  TypeReference(Resource), boolean, string, Quantity, Attachment
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  To convey the data content to be provided when the information is more than a simple code or period.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 100. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]:valueReference
                    Slice NamevalueReference
                    Definition

                    Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                    ShortData to be provided
                    Comments

                    Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                    Control10..1
                    TypeReference(C4BB Organization, Resource), boolean, string, Quantity, Attachment
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    To convey the data content to be provided when the information is more than a simple code or period.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    102. ExplanationOfBenefit.supportingInfo:medicalrecordnumber
                    Slice Namemedicalrecordnumber
                    Definition

                    Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                    ShortMedical record numberSupporting information
                    Comments

                    Provider submitted medical record number that can be included on the claim. (109)


                    Often there are multiple jurisdiction specific valuesets which are required.

                    Control0..1*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    104. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    106. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.sequence
                    Definition

                    A number to uniquely identify supporting information entries.

                    ShortInformation instance identifier
                    Comments

                    Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                    Control1..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    108. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.category
                    Definition

                    The general class of the information supplied: information; exception; accident, employment; onset, etc.

                    ShortClassification of the supplied information
                    Comments

                    This may contain a category for the local bill type codes.

                    Control1..1
                    BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                    (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                    Pattern Value{
                      "coding" : [{
                        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                        "code" : "medicalrecordnumber"
                      }]
                    }
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    110. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]
                    Definition

                    Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                    ShortData to be provided
                    Comments

                    Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                    Control10..1
                    Typestring, boolean, Reference(Resource), Quantity, Attachment
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    To convey the data content to be provided when the information is more than a simple code or period.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 112. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]:valueString
                      Slice NamevalueString
                      Definition

                      Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                      ShortData to be provided
                      Comments

                      Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                      Control10..1
                      Typestring, boolean, Reference(Resource), Quantity, Attachment
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      To convey the data content to be provided when the information is more than a simple code or period.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      114. ExplanationOfBenefit.supportingInfo:patientaccountnumber
                      Slice Namepatientaccountnumber
                      Definition

                      Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                      ShortPatient account numberSupporting information
                      Comments

                      Provider assigned patient account number that can be included on the claim. (109)


                      Often there are multiple jurisdiction specific valuesets which are required.

                      Control0..1*
                      TypeBackboneElement
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      116. ExplanationOfBenefit.supportingInfo:patientaccountnumber.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      118. ExplanationOfBenefit.supportingInfo:patientaccountnumber.sequence
                      Definition

                      A number to uniquely identify supporting information entries.

                      ShortInformation instance identifier
                      Comments

                      Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                      Control1..1
                      TypepositiveInt
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      120. ExplanationOfBenefit.supportingInfo:patientaccountnumber.category
                      Definition

                      The general class of the information supplied: information; exception; accident, employment; onset, etc.

                      ShortClassification of the supplied information
                      Comments

                      This may contain a category for the local bill type codes.

                      Control1..1
                      BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                      (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                      Pattern Value{
                        "coding" : [{
                          "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                          "code" : "patientaccountnumber"
                        }]
                      }
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      122. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]
                      Definition

                      Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                      ShortData to be provided
                      Comments

                      Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                      Control10..1
                      Typestring, boolean, Reference(Resource), Quantity, Attachment
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      To convey the data content to be provided when the information is more than a simple code or period.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                      • type @ $this
                      • 124. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]:valueString
                        Slice NamevalueString
                        Definition

                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                        ShortData to be provided
                        Comments

                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                        Control10..1
                        Typestring, boolean, Reference(Resource), Quantity, Attachment
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        To convey the data content to be provided when the information is more than a simple code or period.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        126. ExplanationOfBenefit.supportingInfo:patientweight
                        Slice Namepatientweight
                        Definition

                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                        ShortSupporting information
                        Comments

                        Defines data elements not available in the base EOB resource


                        Often there are multiple jurisdiction specific valuesets which are required.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        128. ExplanationOfBenefit.supportingInfo:patientweight.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        130. ExplanationOfBenefit.supportingInfo:patientweight.sequence
                        Definition

                        A number to uniquely identify supporting information entries.

                        ShortInformation instance identifier
                        Comments

                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        132. ExplanationOfBenefit.supportingInfo:patientweight.category
                        Definition

                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                        ShortClassification of the supplied information
                        Comments

                        This may contain a category for the local bill type codes.

                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                            "code" : "patientweight"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        134. ExplanationOfBenefit.supportingInfo:patientweight.code
                        Definition

                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                        ShortType of information
                        Comments

                        This may contain the local bill type codes such as the US UB-04 bill type code.

                        Control0..01
                        BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                        The valuset used for additional information codes.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to identify the kind of additional information.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        136. ExplanationOfBenefit.supportingInfo:patientweight.timing[x]
                        Definition

                        The date when or period to which this information refers.

                        ShortWhen it occurred
                        Control0..01
                        TypeChoice of: date, Period
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        138. ExplanationOfBenefit.supportingInfo:patientweight.value[x]
                        Definition

                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                        ShortData to be provided
                        Comments

                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                        Control10..1
                        TypeQuantity, boolean, string, Reference(Resource), Attachment
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        To convey the data content to be provided when the information is more than a simple code or period.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        140. ExplanationOfBenefit.supportingInfo:patientweight.value[x].value
                        Definition

                        The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                        ShortNumerical value (with implicit precision)
                        Comments

                        The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                        Control10..1
                        Typedecimal
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Precision is handled implicitly in almost all cases of measurement.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        142. ExplanationOfBenefit.supportingInfo:patientweight.value[x].comparator
                        Definition

                        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                        Short< | <= | >= | > - how to understand the value
                        Control0..1
                        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                        How the Quantity should be understood and represented.

                        Typecode
                        Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        144. ExplanationOfBenefit.supportingInfo:patientweight.value[x].unit
                        Definition

                        A human-readable form of the unit.

                        ShortUnit representation
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                        Pattern Value[lb_av]
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        146. ExplanationOfBenefit.supportingInfo:patientweight.value[x].system
                        Definition

                        The identification of the system that provides the coded form of the unit.

                        ShortSystem that defines coded unit form
                        Control0..1
                        This element is affected by the following invariants: qty-3
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to know the system that defines the coded form of the unit.

                        Pattern Valuehttp://unitsofmeasure.org
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        148. ExplanationOfBenefit.supportingInfo:ambulancetransportreason
                        Slice Nameambulancetransportreason
                        Definition

                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                        ShortSupporting information
                        Comments

                        Defines data elements not available in the base EOB resource


                        Often there are multiple jurisdiction specific valuesets which are required.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        150. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        152. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.sequence
                        Definition

                        A number to uniquely identify supporting information entries.

                        ShortInformation instance identifier
                        Comments

                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        154. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.category
                        Definition

                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                        ShortClassification of the supplied information
                        Comments

                        This may contain a category for the local bill type codes.

                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                            "code" : "ambulancetransportreason"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        156. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.code
                        Definition

                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                        ShortType of information
                        Comments

                        This may contain the local bill type codes such as the US UB-04 bill type code.

                        Control0..01
                        BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                        The valuset used for additional information codes.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to identify the kind of additional information.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        158. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.timing[x]
                        Definition

                        The date when or period to which this information refers.

                        ShortWhen it occurred
                        Control0..01
                        TypeChoice of: date, Period
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        160. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.reason
                        Definition

                        Provides the reason in the situation where a reason code is required in addition to the content.

                        ShortExplanation for the information
                        Comments

                        For example: the reason for the additional stay, or why a tooth is missing.

                        Control10..1
                        BindingThe codes SHALL be taken from For example codes, see C4BB Ambulance Transport Reasons Value Sethttp://hl7.org/fhir/ValueSet/missing-tooth-reason
                        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAmbulanceTransportReasonCodes)
                        TypeCoding
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Needed when the supporting information has both a date and amount/value and requires explanation.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        162. ExplanationOfBenefit.supportingInfo:transportationdistance
                        Slice Nametransportationdistance
                        Definition

                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                        ShortSupporting information
                        Comments

                        Defines data elements not available in the base EOB resource


                        Often there are multiple jurisdiction specific valuesets which are required.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        164. ExplanationOfBenefit.supportingInfo:transportationdistance.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        166. ExplanationOfBenefit.supportingInfo:transportationdistance.sequence
                        Definition

                        A number to uniquely identify supporting information entries.

                        ShortInformation instance identifier
                        Comments

                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        168. ExplanationOfBenefit.supportingInfo:transportationdistance.category
                        Definition

                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                        ShortClassification of the supplied information
                        Comments

                        This may contain a category for the local bill type codes.

                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                            "code" : "transportationdistance"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        170. ExplanationOfBenefit.supportingInfo:transportationdistance.code
                        Definition

                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                        ShortType of information
                        Comments

                        This may contain the local bill type codes such as the US UB-04 bill type code.

                        Control0..01
                        BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                        The valuset used for additional information codes.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to identify the kind of additional information.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        172. ExplanationOfBenefit.supportingInfo:transportationdistance.timing[x]
                        Definition

                        The date when or period to which this information refers.

                        ShortWhen it occurred
                        Control0..01
                        TypeChoice of: date, Period
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        174. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]
                        Definition

                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                        ShortData to be provided
                        Comments

                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                        Control10..1
                        TypeQuantity, boolean, string, Reference(Resource), Attachment
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        To convey the data content to be provided when the information is more than a simple code or period.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        176. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].value
                        Definition

                        The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                        ShortNumerical value (with implicit precision)
                        Comments

                        The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                        Control10..1
                        Typedecimal
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Precision is handled implicitly in almost all cases of measurement.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        178. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].comparator
                        Definition

                        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                        Short< | <= | >= | > - how to understand the value
                        Control0..1
                        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                        How the Quantity should be understood and represented.

                        Typecode
                        Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        180. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].unit
                        Definition

                        A human-readable form of the unit.

                        ShortUnit representation
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                        Pattern Value[mi_i]
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        182. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].system
                        Definition

                        The identification of the system that provides the coded form of the unit.

                        ShortSystem that defines coded unit form
                        Control0..1
                        This element is affected by the following invariants: qty-3
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to know the system that defines the coded form of the unit.

                        Pattern Valuehttp://unitsofmeasure.org
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        184. ExplanationOfBenefit.supportingInfo:roudtrippurpose
                        Slice Nameroudtrippurpose
                        Definition

                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                        ShortSupporting information
                        Comments

                        Defines data elements not available in the base EOB resource


                        Often there are multiple jurisdiction specific valuesets which are required.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        186. ExplanationOfBenefit.supportingInfo:roudtrippurpose.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        188. ExplanationOfBenefit.supportingInfo:roudtrippurpose.sequence
                        Definition

                        A number to uniquely identify supporting information entries.

                        ShortInformation instance identifier
                        Comments

                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        190. ExplanationOfBenefit.supportingInfo:roudtrippurpose.category
                        Definition

                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                        ShortClassification of the supplied information
                        Comments

                        This may contain a category for the local bill type codes.

                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                            "code" : "roudtrippurpose"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        192. ExplanationOfBenefit.supportingInfo:roudtrippurpose.code
                        Definition

                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                        ShortType of information
                        Comments

                        This may contain the local bill type codes such as the US UB-04 bill type code.

                        Control0..01
                        BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                        The valuset used for additional information codes.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to identify the kind of additional information.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        194. ExplanationOfBenefit.supportingInfo:roudtrippurpose.timing[x]
                        Definition

                        The date when or period to which this information refers.

                        ShortWhen it occurred
                        Control0..01
                        TypeChoice of: date, Period
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        196. ExplanationOfBenefit.supportingInfo:roudtrippurpose.value[x]
                        Definition

                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                        ShortData to be provided
                        Comments

                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                        Control10..1
                        Typestring, boolean, Reference(Resource), Quantity, Attachment
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        To convey the data content to be provided when the information is more than a simple code or period.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        198. ExplanationOfBenefit.supportingInfo:stretcherpurpose
                        Slice Namestretcherpurpose
                        Definition

                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                        ShortSupporting information
                        Comments

                        Defines data elements not available in the base EOB resource


                        Often there are multiple jurisdiction specific valuesets which are required.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        200. ExplanationOfBenefit.supportingInfo:stretcherpurpose.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        202. ExplanationOfBenefit.supportingInfo:stretcherpurpose.sequence
                        Definition

                        A number to uniquely identify supporting information entries.

                        ShortInformation instance identifier
                        Comments

                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        204. ExplanationOfBenefit.supportingInfo:stretcherpurpose.category
                        Definition

                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                        ShortClassification of the supplied information
                        Comments

                        This may contain a category for the local bill type codes.

                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                            "code" : "stretcherpurpose"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        206. ExplanationOfBenefit.supportingInfo:stretcherpurpose.code
                        Definition

                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                        ShortType of information
                        Comments

                        This may contain the local bill type codes such as the US UB-04 bill type code.

                        Control0..01
                        BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                        The valuset used for additional information codes.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to identify the kind of additional information.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        208. ExplanationOfBenefit.supportingInfo:stretcherpurpose.timing[x]
                        Definition

                        The date when or period to which this information refers.

                        ShortWhen it occurred
                        Control0..01
                        TypeChoice of: date, Period
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        210. ExplanationOfBenefit.supportingInfo:stretcherpurpose.value[x]
                        Definition

                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                        ShortData to be provided
                        Comments

                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                        Control10..1
                        Typestring, boolean, Reference(Resource), Quantity, Attachment
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        To convey the data content to be provided when the information is more than a simple code or period.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        212. ExplanationOfBenefit.supportingInfo:pickuplocation
                        Slice Namepickuplocation
                        Definition

                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                        ShortSupporting information
                        Comments

                        Defines data elements not available in the base EOB resource


                        Often there are multiple jurisdiction specific valuesets which are required.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        214. ExplanationOfBenefit.supportingInfo:pickuplocation.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        216. ExplanationOfBenefit.supportingInfo:pickuplocation.sequence
                        Definition

                        A number to uniquely identify supporting information entries.

                        ShortInformation instance identifier
                        Comments

                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        218. ExplanationOfBenefit.supportingInfo:pickuplocation.category
                        Definition

                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                        ShortClassification of the supplied information
                        Comments

                        This may contain a category for the local bill type codes.

                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                            "code" : "pickuplocation"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        220. ExplanationOfBenefit.supportingInfo:pickuplocation.code
                        Definition

                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                        ShortType of information
                        Comments

                        This may contain the local bill type codes such as the US UB-04 bill type code.

                        Control0..01
                        BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                        The valuset used for additional information codes.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to identify the kind of additional information.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        222. ExplanationOfBenefit.supportingInfo:pickuplocation.timing[x]
                        Definition

                        The date when or period to which this information refers.

                        ShortWhen it occurred
                        Control0..01
                        TypeChoice of: date, Period
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        224. ExplanationOfBenefit.supportingInfo:pickuplocation.value[x]
                        Definition

                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                        ShortData to be provided
                        Comments

                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                        Control10..1
                        Typestring, boolean, Reference(Resource), Quantity, Attachment
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        To convey the data content to be provided when the information is more than a simple code or period.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        226. ExplanationOfBenefit.supportingInfo:dropofflocation
                        Slice Namedropofflocation
                        Definition

                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                        ShortSupporting information
                        Comments

                        Defines data elements not available in the base EOB resource


                        Often there are multiple jurisdiction specific valuesets which are required.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        228. ExplanationOfBenefit.supportingInfo:dropofflocation.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        230. ExplanationOfBenefit.supportingInfo:dropofflocation.sequence
                        Definition

                        A number to uniquely identify supporting information entries.

                        ShortInformation instance identifier
                        Comments

                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        232. ExplanationOfBenefit.supportingInfo:dropofflocation.category
                        Definition

                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                        ShortClassification of the supplied information
                        Comments

                        This may contain a category for the local bill type codes.

                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                            "code" : "dropofflocation"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        234. ExplanationOfBenefit.supportingInfo:dropofflocation.code
                        Definition

                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                        ShortType of information
                        Comments

                        This may contain the local bill type codes such as the US UB-04 bill type code.

                        Control0..01
                        BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                        The valuset used for additional information codes.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required to identify the kind of additional information.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        236. ExplanationOfBenefit.supportingInfo:dropofflocation.timing[x]
                        Definition

                        The date when or period to which this information refers.

                        ShortWhen it occurred
                        Control0..01
                        TypeChoice of: date, Period
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        238. ExplanationOfBenefit.supportingInfo:dropofflocation.value[x]
                        Definition

                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                        ShortData to be provided
                        Comments

                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                        Control10..1
                        Typestring, boolean, Reference(Resource), Quantity, Attachment
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        To convey the data content to be provided when the information is more than a simple code or period.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        240. ExplanationOfBenefit.diagnosis
                        Definition

                        Information about diagnoses relevant to the claim items.

                        ShortPertinent diagnosis information
                        Comments

                        Diagnosis codes describe an individual's disease or medical condition. (6, 7, 8, 21, 22, 23, 30)

                        Control10..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Required for the adjudication by provided context for the services and product listed.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        242. ExplanationOfBenefit.diagnosis.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        244. ExplanationOfBenefit.diagnosis.sequence
                        Definition

                        A number to uniquely identify diagnosis entries.

                        ShortDiagnosis instance identifier
                        Comments

                        Diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. client app implementations should not assign any significance to the sequence values. client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.


                        Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        246. ExplanationOfBenefit.diagnosis.diagnosis[x]
                        Definition

                        The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                        ShortNature of illness or problem
                        Control1..1
                        BindingThe codes SHALL be taken from For example codes, see Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Sethttp://hl7.org/fhir/ValueSet/icd-10
                        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CDCICD910CMDiagnosisCodes)
                        TypeCodeableConcept, Reference(Condition)
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Provides health context for the evaluation of the products and/or services.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        248. ExplanationOfBenefit.diagnosis.type
                        Definition

                        When the condition was observed or the relative ranking.

                        ShortTiming or nature of the diagnosis
                        Comments

                        Indicates if the professional and non-clinician diagnosis is principal or secondary (21, 22, 23)


                        For example: admitting, primary, secondary, discharge.

                        Control10..1*
                        BindingThe codes SHALL be taken from For example codes, see C4BB Claim Professional And Non Clinician Diagnosis Type Value Sethttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianDiagnosisType)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Often required to capture a particular diagnosis, for example: primary or discharge.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        250. ExplanationOfBenefit.insurance
                        Definition

                        Financial instruments for reimbursement for the health care products and services specified on the claim.

                        ShortPatient insurance information
                        Comments

                        Identity of the payers responsible for the claim. (2, 141). All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'


                        All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

                        Control1..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        At least one insurer is required for a claim to be a claim.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        EOB-insurance-focal: EOB.insurance: at most one with focal = true (select (focal = true).count() < 2)
                        252. ExplanationOfBenefit.insurance.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        254. ExplanationOfBenefit.insurance.focal
                        Definition

                        A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

                        ShortCoverage to be used for adjudication
                        Comments

                        A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'


                        A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.

                        Control1..1
                        Typeboolean
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        To identify which coverage in the list is being used to adjudicate this claim.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        256. ExplanationOfBenefit.insurance.coverage
                        Definition

                        Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

                        ShortInsurance information
                        Comments

                        Same as insurance.coverage.organization. Party responsible for reimbursing the provider. When focal = true, Coverage.payer--> Organization.identifier. When focal = false, EOB.insurance.coverage.display = [name of other carrier]

                        Control1..1
                        TypeReference(C4BB Coverage, Coverage)
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Required to allow the adjudicator to locate the correct policy and history within their information system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        258. ExplanationOfBenefit.item
                        Definition

                        A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.

                        ShortProduct or service provided
                        Control10..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        The items to be processed for adjudication.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        260. ExplanationOfBenefit.item.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        262. ExplanationOfBenefit.item.sequence
                        Definition

                        A number to uniquely identify item entries.

                        ShortItem instance identifier
                        Comments

                        Line identification number that represents the number assigned in a source system for identification and processing. (36)

                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        264. ExplanationOfBenefit.item.productOrService
                        Definition

                        When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                        ShortBilling, service, product, or drug code
                        Comments

                        Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40)


                        If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                        Control1..1
                        BindingThe codes SHALL be taken from For example codes, see Procedure Codes - AMA CPT - CMS HCPCS Value Sethttp://hl7.org/fhir/ValueSet/service-uscls
                        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSProcedureCodes)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Necessary to state what was provided or done.

                        Alternate NamesDrug Code, Bill Code, Service Code
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        266. ExplanationOfBenefit.item.modifier
                        Definition

                        Item typification or modifiers codes to convey additional context for the product or service.

                        ShortProduct or service billing modifiers
                        Comments

                        Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41)


                        For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                        Control0..*
                        BindingThe codes SHALL be taken from For example codes, see Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Sethttp://hl7.org/fhir/ValueSet/claim-modifiers
                        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        To support inclusion of the item for adjudication or to charge an elevated fee.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        268. ExplanationOfBenefit.item.serviced[x]
                        Definition

                        The date or dates when the service or product was supplied, performed or completed.

                        ShortDate or dates of service or product delivery
                        Comments

                        Date services began/ended. Located on CMS 1500 (Form Locator 24A) (118)

                        Control10..1
                        TypeChoice of: date, Period
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Needed to determine whether the service or product was provided during the term of the insurance coverage.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        270. ExplanationOfBenefit.item.location[x]
                        Definition

                        Where the product or service was provided.

                        ShortPlace of service or where product was supplied
                        Comments

                        Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed. (46)

                        Control10..1
                        BindingThe codes SHALL be taken from For example codes, see CMS Place of Service Codes (POS) Value Sethttp://hl7.org/fhir/ValueSet/service-place
                        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CMSPlaceofServiceCodes)
                        TypeCodeableConcept, Address, Reference(Location)
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        272. ExplanationOfBenefit.item.quantity
                        Definition

                        The number of repetitions of a service or product.

                        ShortCount of products or services
                        Comments

                        The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code or CPT procedure code, submitted by the provider. (42)

                        Control0..1
                        TypeQuantity(SimpleQuantity)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required when the product or service code does not convey the quantity provided.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        274. ExplanationOfBenefit.item.noteNumber
                        Definition

                        The numbers associated with notes below which apply to the adjudication of this item.

                        ShortApplicable note numbers
                        Comments

                        References number of the associated processNote entered

                        Control0..*
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        276. ExplanationOfBenefit.item.adjudication
                        Definition

                        If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                        ShortAdjudication details
                        Control10..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on ExplanationOfBenefit.item.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • pattern @ category
                        • 278. ExplanationOfBenefit.item.adjudication.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          280. ExplanationOfBenefit.item.adjudication.category
                          Definition

                          A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                          ShortType of adjudication information
                          Comments

                          For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                          Control1..1
                          BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB Adjudication Category Discriminator Value Sethttp://hl7.org/fhir/ValueSet/adjudication
                          (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Needed to enable understanding of the context of the other information in the adjudication.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          282. ExplanationOfBenefit.item.adjudication:adjustmentreason
                          Slice Nameadjustmentreason
                          Definition

                          If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                          ShortReason codes used to interpret the Non-Covered Amount (92)Adjudication details
                          Comments

                          Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)

                          Control0..1*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          284. ExplanationOfBenefit.item.adjudication:adjustmentreason.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          286. ExplanationOfBenefit.item.adjudication:adjustmentreason.category
                          Definition

                          A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                          ShortType of adjudication information
                          Comments

                          For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                          Control1..1
                          BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
                          (example to http://hl7.org/fhir/ValueSet/adjudication)

                          The adjudication codes.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Needed to enable understanding of the context of the other information in the adjudication.

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                              "code" : "adjustmentreason"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          288. ExplanationOfBenefit.item.adjudication:adjustmentreason.reason
                          Definition

                          A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                          ShortExplanation of adjudication outcome
                          Comments

                          For example, may indicate that the funds for this benefit type have been exhausted.

                          Control10..1
                          BindingThe codes SHALL be taken from For example codes, see X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Sethttp://hl7.org/fhir/ValueSet/adjudication-reason
                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          To support understanding of variance from adjudication expectations.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          290. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus
                          Slice Namebenefitpaymentstatus
                          Definition

                          If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                          ShortIndicates the in network or out of network payment status of the claim. (142)Adjudication details
                          Comments

                          Indicates the in network or out of network payment status of the claim. (142)

                          Control10..1*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          292. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          294. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.category
                          Definition

                          A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                          ShortType of adjudication information
                          Comments

                          For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                          Control1..1
                          BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
                          (example to http://hl7.org/fhir/ValueSet/adjudication)

                          The adjudication codes.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Needed to enable understanding of the context of the other information in the adjudication.

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                              "code" : "benefitpaymentstatus"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          296. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.reason
                          Definition

                          A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                          ShortExplanation of adjudication outcome
                          Comments

                          For example, may indicate that the funds for this benefit type have been exhausted.

                          Control10..1
                          BindingThe codes SHALL be taken from For example codes, see C4BB Payer Benefit Payment Status Value Sethttp://hl7.org/fhir/ValueSet/adjudication-reason
                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerBenefitPaymentStatus)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          To support understanding of variance from adjudication expectations.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          298. ExplanationOfBenefit.item.adjudication:allowedunits
                          Slice Nameallowedunits
                          Definition

                          If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                          ShortThe quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)Adjudication details
                          Comments

                          The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)

                          Control0..1*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          300. ExplanationOfBenefit.item.adjudication:allowedunits.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          302. ExplanationOfBenefit.item.adjudication:allowedunits.category
                          Definition

                          A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                          ShortType of adjudication information
                          Comments

                          For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                          Control1..1
                          BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
                          (example to http://hl7.org/fhir/ValueSet/adjudication)

                          The adjudication codes.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Needed to enable understanding of the context of the other information in the adjudication.

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                              "code" : "allowedunits"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          304. ExplanationOfBenefit.adjudication
                          Definition

                          The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                          ShortHeader-level adjudication
                          Control0..*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          SlicingThis element introduces a set of slices on ExplanationOfBenefit.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • pattern @ category
                          • 306. ExplanationOfBenefit.adjudication.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            308. ExplanationOfBenefit.adjudication.category
                            Definition

                            A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                            ShortType of adjudication information
                            Comments

                            For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB Adjudication Category Discriminator Value Sethttp://hl7.org/fhir/ValueSet/adjudication
                            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Needed to enable understanding of the context of the other information in the adjudication.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            310. ExplanationOfBenefit.adjudication:billingnetworkstatus
                            Slice Namebillingnetworkstatus
                            Definition

                            The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                            ShortBilling provider networking statusHeader-level adjudication
                            Comments

                            Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101)

                            Control0..1*
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            312. ExplanationOfBenefit.adjudication:billingnetworkstatus.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            314. ExplanationOfBenefit.adjudication:billingnetworkstatus.category
                            Definition

                            A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                            ShortType of adjudication information
                            Comments

                            For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                            Control1..1
                            BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
                            (example to http://hl7.org/fhir/ValueSet/adjudication)

                            The adjudication codes.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Needed to enable understanding of the context of the other information in the adjudication.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                "code" : "billingnetworkstatus"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            316. ExplanationOfBenefit.adjudication:billingnetworkstatus.reason
                            Definition

                            A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                            ShortExplanation of adjudication outcome
                            Comments

                            For example, may indicate that the funds for this benefit type have been exhausted.

                            Control10..1
                            BindingThe codes SHALL be taken from For example codes, see C4BB Payer Provider Network Status Value Sethttp://hl7.org/fhir/ValueSet/adjudication-reason
                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            To support understanding of variance from adjudication expectations.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            318. ExplanationOfBenefit.adjudication:renderingnetworkstatus
                            Slice Namerenderingnetworkstatus
                            Definition

                            The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                            ShortRendering provider networking statusHeader-level adjudication
                            Comments

                            Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission. (101)

                            Control0..1*
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            320. ExplanationOfBenefit.adjudication:renderingnetworkstatus.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            322. ExplanationOfBenefit.adjudication:renderingnetworkstatus.category
                            Definition

                            A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                            ShortType of adjudication information
                            Comments

                            For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                            Control1..1
                            BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
                            (example to http://hl7.org/fhir/ValueSet/adjudication)

                            The adjudication codes.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Needed to enable understanding of the context of the other information in the adjudication.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                "code" : "renderingnetworkstatus"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            324. ExplanationOfBenefit.adjudication:renderingnetworkstatus.reason
                            Definition

                            A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                            ShortExplanation of adjudication outcome
                            Comments

                            For example, may indicate that the funds for this benefit type have been exhausted.

                            Control10..1
                            BindingThe codes SHALL be taken from For example codes, see C4BB Payer Provider Network Status Value Sethttp://hl7.org/fhir/ValueSet/adjudication-reason
                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            To support understanding of variance from adjudication expectations.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            326. ExplanationOfBenefit.payment
                            Definition

                            Payment details for the adjudication of the claim.

                            ShortPayment Details
                            Control0..1
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Needed to convey references to the financial instrument that has been used if payment has been made.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            328. ExplanationOfBenefit.payment.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            330. ExplanationOfBenefit.payment.type
                            Definition

                            Whether this represents partial or complete payment of the benefits payable.

                            ShortPartial or complete payment
                            Comments

                            Indicates whether the claim was paid or denied. (91)

                            Control0..1
                            BindingThe codes SHALL be taken from For example codes, see C4BB Payer Claim Payment Status Code Value Sethttp://hl7.org/fhir/ValueSet/ex-paymenttype
                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            To advise the requestor when the insurer believes all payments to have been completed.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            332. ExplanationOfBenefit.processNote
                            Definition

                            A note that describes or explains adjudication results in a human readable form.

                            ShortNote concerning adjudication
                            Control0..*
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Provides the insurer specific textual explanations associated with the processing.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            334. ExplanationOfBenefit.processNote.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())

                            Guidance on how to interpret the contents of this table can be found here

                            0. ExplanationOfBenefit
                            Definition

                            This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.

                            ShortExplanation of Benefit resource
                            Control0..*
                            Is Modifierfalse
                            Summaryfalse
                            Alternate NamesEOB
                            Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                            dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                            dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                            dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                            dom-6: A resource should have narrative for robust management (text.`div`.exists())
                            EOB-prof-all-transportation-supportinginfo-linked-to-line: Professional EOB: SupportingInfo repetitions with with transportation category code must be referred to by one or more repetitions of item.informationSequence (supportingInfo.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTransportationServiceCategories')).sequence.subsetOf(%context.item.informationSequence))
                            EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. (type.coding.where(code = 'vision' and system='http://terminology.hl7.org/CodeSystem/claim-type').exists() or item.productOrService.coding.where(code = 'not-applicable' and system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists().not())
                            2. ExplanationOfBenefit.id
                            Definition

                            The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                            ShortLogical id of this artifact
                            Comments

                            The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                            Control0..1
                            Typeid
                            Is Modifierfalse
                            Summarytrue
                            4. ExplanationOfBenefit.meta
                            Definition

                            The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                            ShortMetadata about the resource
                            Control1..1
                            TypeMeta
                            Is Modifierfalse
                            Must Supporttrue
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            6. ExplanationOfBenefit.meta.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            8. ExplanationOfBenefit.meta.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on ExplanationOfBenefit.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 10. ExplanationOfBenefit.meta.versionId
                              Definition

                              The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                              ShortVersion specific identifier
                              Comments

                              The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

                              Control0..1
                              Typeid
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              12. ExplanationOfBenefit.meta.lastUpdated
                              Definition

                              When the resource last changed - e.g. when the version changed.

                              ShortWhen the resource version last changed
                              Comments

                              Defines the date the Resource was created or updated, whichever comes last (163). Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last

                              Control1..1
                              Typeinstant
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              14. ExplanationOfBenefit.meta.source
                              Definition

                              A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                              ShortIdentifies where the resource comes from
                              Comments

                              In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

                              This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

                              Control0..1
                              Typeuri
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              16. ExplanationOfBenefit.meta.profile
                              Definition

                              A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                              ShortProfiles this resource claims to conform to
                              Comments

                              meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest. CPCDS data element (190)

                              Control1..*
                              Typecanonical(StructureDefinition)
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              18. ExplanationOfBenefit.meta.security
                              Definition

                              Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                              ShortSecurity Labels applied to this resource
                              Comments

                              The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                              Control0..*
                              BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                              (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                              Security Labels from the Healthcare Privacy and Security Classification System.

                              TypeCoding
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              20. ExplanationOfBenefit.meta.tag
                              Definition

                              Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                              ShortTags applied to this resource
                              Comments

                              The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

                              Control0..*
                              BindingFor example codes, see CommonTags
                              (example to http://hl7.org/fhir/ValueSet/common-tags)

                              Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

                              TypeCoding
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              22. ExplanationOfBenefit.implicitRules
                              Definition

                              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                              ShortA set of rules under which this content was created
                              Comments

                              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                              Control0..1
                              Typeuri
                              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              24. ExplanationOfBenefit.language
                              Definition

                              The base language in which the resource is written.

                              ShortLanguage of the resource content
                              Comments

                              Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                              Control0..1
                              BindingThe codes SHOULD be taken from CommonLanguages
                              (preferred to http://hl7.org/fhir/ValueSet/languages)

                              A human language.

                              Additional BindingsPurpose
                              AllLanguagesMax Binding
                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              26. ExplanationOfBenefit.text
                              Definition

                              A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                              ShortText summary of the resource, for human interpretation
                              Comments

                              Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                              Control0..1
                              TypeNarrative
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesnarrative, html, xhtml, display
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              28. ExplanationOfBenefit.contained
                              Definition

                              These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                              ShortContained, inline Resources
                              Comments

                              This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                              Control0..*
                              TypeResource
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesinline resources, anonymous resources, contained resources
                              30. ExplanationOfBenefit.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              32. ExplanationOfBenefit.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                              Summaryfalse
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              34. ExplanationOfBenefit.identifier
                              Definition

                              A unique identifier assigned to this explanation of benefit.

                              ShortBusiness Identifier for the resource
                              Comments

                              Identifier assigned by a payer for a claim received from a provider or subscriber. It is not the same identifier as that assigned by a provider. (35)

                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control1..*
                              TypeIdentifier
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Allows EOBs to be distinguished and referenced.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              SlicingThis element introduces a set of slices on ExplanationOfBenefit.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • pattern @ type
                              • 36. ExplanationOfBenefit.identifier.id
                                Definition

                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                38. ExplanationOfBenefit.identifier.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                SlicingThis element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 40. ExplanationOfBenefit.identifier.use
                                  Definition

                                  The purpose of this identifier.

                                  Shortusual | official | temp | secondary | old (If known)
                                  Comments

                                  Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                  Control0..1
                                  BindingThe codes SHALL be taken from IdentifierUse
                                  (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                  Identifies the purpose for this identifier, if known .

                                  Typecode
                                  Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  42. ExplanationOfBenefit.identifier.type
                                  Definition

                                  A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                  ShortDescription of identifier
                                  Comments

                                  Indicates that the claim identifier is that assigned by a payer for a claim received from a provider or subscriber. (183)

                                  Control0..1
                                  BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                  (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                  A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  Allows users to make use of identifiers when the identifier system is not known.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  44. ExplanationOfBenefit.identifier.system
                                  Definition

                                  Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                  ShortThe namespace for the identifier value
                                  Comments

                                  Identifier.system is always case sensitive.

                                  Control0..1
                                  Typeuri
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                  Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  46. ExplanationOfBenefit.identifier.value
                                  Definition

                                  The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                  ShortThe value that is unique
                                  Comments

                                  If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Example<br/><b>General</b>:123456
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  48. ExplanationOfBenefit.identifier.period
                                  Definition

                                  Time period during which identifier is/was valid for use.

                                  ShortTime period when id is/was valid for use
                                  Control0..1
                                  TypePeriod
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  50. ExplanationOfBenefit.identifier.assigner
                                  Definition

                                  Organization that issued/manages the identifier.

                                  ShortOrganization that issued id (may be just text)
                                  Comments

                                  The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                  Control0..1
                                  TypeReference(Organization)
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  52. ExplanationOfBenefit.identifier:uniqueclaimid
                                  Slice Nameuniqueclaimid
                                  Definition

                                  A unique identifier assigned to this explanation of benefit.

                                  ShortUnique Claim Identifier
                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                  Control1..1
                                  TypeIdentifier
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Requirements

                                  Allows EOBs to be distinguished and referenced.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  54. ExplanationOfBenefit.identifier:uniqueclaimid.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  56. ExplanationOfBenefit.identifier:uniqueclaimid.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  SlicingThis element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 58. ExplanationOfBenefit.identifier:uniqueclaimid.use
                                    Definition

                                    The purpose of this identifier.

                                    Shortusual | official | temp | secondary | old (If known)
                                    Comments

                                    Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                    Control0..1
                                    BindingThe codes SHALL be taken from IdentifierUse
                                    (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                    Identifies the purpose for this identifier, if known .

                                    Typecode
                                    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    60. ExplanationOfBenefit.identifier:uniqueclaimid.type
                                    Definition

                                    A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                    ShortDescription of identifier
                                    Comments

                                    This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                    Control1..1
                                    BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                    (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                    A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summarytrue
                                    Requirements

                                    Allows users to make use of identifiers when the identifier system is not known.

                                    Pattern Value{
                                      "coding" : [{
                                        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                                        "code" : "uc"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    62. ExplanationOfBenefit.identifier:uniqueclaimid.system
                                    Definition

                                    Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                    ShortThe namespace for the identifier value
                                    Comments

                                    Identifier.system is always case sensitive.

                                    Control0..1
                                    Typeuri
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                    Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    64. ExplanationOfBenefit.identifier:uniqueclaimid.value
                                    Definition

                                    The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                    ShortUnique Claim Identifier
                                    Comments

                                    If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                    Control1..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Example<br/><b>General</b>:123456
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    66. ExplanationOfBenefit.identifier:uniqueclaimid.period
                                    Definition

                                    Time period during which identifier is/was valid for use.

                                    ShortTime period when id is/was valid for use
                                    Control0..1
                                    TypePeriod
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    68. ExplanationOfBenefit.identifier:uniqueclaimid.assigner
                                    Definition

                                    Organization that issued/manages the identifier.

                                    ShortOrganization that issued id (may be just text)
                                    Comments

                                    The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                    Control0..1
                                    TypeReference(Organization)
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    70. ExplanationOfBenefit.status
                                    Definition

                                    The status of the resource instance.

                                    Shortactive | cancelled | draft | entered-in-error
                                    Comments

                                    Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required

                                    Control1..1
                                    BindingThe codes SHALL be taken from ExplanationOfBenefitStatus
                                    (required to http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1)

                                    A code specifying the state of the resource instance.

                                    Typecode
                                    Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    72. ExplanationOfBenefit.type
                                    Definition

                                    The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

                                    ShortCategory or discipline
                                    Comments

                                    Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.) (16). Defines the Claims profiles. Values from Claim Type Codes are required; a data absent reason is not allowed

                                    Control1..1
                                    BindingThe codes SHALL be taken from C4BB Professional And Non Clinician Claim Type Value Set
                                    (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBProfessionalAndNonClinicianClaimType)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Claim type determine the general sets of business rules applied for information requirements and adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    74. ExplanationOfBenefit.subType
                                    Definition

                                    A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

                                    ShortMore granular claim type
                                    Comments

                                    This may contain the local bill type codes such as the US UB-04 bill type code.

                                    Control0..1
                                    BindingFor example codes, see ExampleClaimSubTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/claim-subtype)

                                    A more granular claim typecode.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Some jurisdictions need a finer grained claim type for routing and adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    76. ExplanationOfBenefit.use
                                    Definition

                                    A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

                                    Shortclaim | preauthorization | predetermination
                                    Comments

                                    Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations

                                    Control1..1
                                    BindingThe codes SHALL be taken from Use
                                    (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

                                    Complete, proposed, exploratory, other.

                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    This element is required to understand the nature of the request for adjudication.

                                    Pattern Valueclaim
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    78. ExplanationOfBenefit.patient
                                    Definition

                                    The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.

                                    ShortThe recipient of the products and services
                                    Comments

                                    Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided. (1). The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudication. Additional required path:EOB.insurance.coverage(Coverage).beneficiary(Patient).identifier

                                    Control1..1
                                    TypeReference(C4BB Patient)
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    80. ExplanationOfBenefit.billablePeriod
                                    Definition

                                    The period for which charges are being submitted.

                                    ShortRelevant time frame for the claim
                                    Comments

                                    Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified.

                                    Control1..1
                                    TypePeriod
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    82. ExplanationOfBenefit.billablePeriod.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    84. ExplanationOfBenefit.billablePeriod.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    SlicingThis element introduces a set of slices on ExplanationOfBenefit.billablePeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 86. ExplanationOfBenefit.billablePeriod.start
                                      Definition

                                      The start of the period. The boundary is inclusive.

                                      ShortStarting time with inclusive boundary
                                      Comments

                                      The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177)

                                      Control1..1
                                      This element is affected by the following invariants: per-1
                                      TypedateTime
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supporttrue
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      88. ExplanationOfBenefit.billablePeriod.end
                                      Definition

                                      The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                                      ShortEnd time with inclusive boundary, if not ongoing
                                      Comments

                                      The last day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers Thru Date’). (178)

                                      Control0..1
                                      This element is affected by the following invariants: per-1
                                      TypedateTime
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      90. ExplanationOfBenefit.created
                                      Definition

                                      The date this resource was created.

                                      ShortResponse creation date
                                      Comments

                                      Date the claim was adjudicated (179)

                                      Control1..1
                                      TypedateTime
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to record a timestamp for use by both the recipient and the issuer.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      92. ExplanationOfBenefit.enterer
                                      Definition

                                      Individual who created the claim, predetermination or preauthorization.

                                      ShortAuthor of the claim
                                      Control0..1
                                      TypeReference(Practitioner, PractitionerRole)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Some jurisdictions require the contact information for personnel completing claims.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      94. ExplanationOfBenefit.insurer
                                      Definition

                                      The party responsible for authorization, adjudication and reimbursement.

                                      ShortParty responsible for reimbursement
                                      Comments

                                      Code of the payer responsible for the claim (2, 5). Same as insurance.coverage.organization. Party responsible for reimbursing the provider

                                      Control1..1
                                      TypeReference(C4BB Organization)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summarytrue
                                      Requirements

                                      To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      96. ExplanationOfBenefit.provider
                                      Definition

                                      The provider which is responsible for the claim, predetermination or preauthorization.

                                      ShortParty responsible for the claim
                                      Comments

                                      The identifier assigned to the Billing Provider. (94)

                                      Control1..1
                                      TypeReference(C4BB Organization, C4BB Practitioner)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Must Support TypesNo must-support rules about the choice of types/profiles
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      98. ExplanationOfBenefit.priority
                                      Definition

                                      The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

                                      ShortDesired processing urgency
                                      Comments

                                      If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.

                                      Control0..1
                                      BindingThe codes SHALL be taken from ProcessPriorityCodes
                                      (required to http://hl7.org/fhir/ValueSet/process-priority)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      100. ExplanationOfBenefit.fundsReserveRequested
                                      Definition

                                      A code to indicate whether and for whom funds are to be reserved for future claims.

                                      ShortFor whom to reserve funds
                                      Comments

                                      This field is only used for preauthorizations.

                                      Control0..1
                                      BindingFor example codes, see Funds Reservation Codes
                                      (example to http://hl7.org/fhir/ValueSet/fundsreserve)

                                      For whom funds are to be reserved: (Patient, Provider, None).

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

                                      Alternate NamesFund pre-allocation
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      102. ExplanationOfBenefit.fundsReserve
                                      Definition

                                      A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.

                                      ShortFunds reserved status
                                      Comments

                                      Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.

                                      Control0..1
                                      BindingFor example codes, see Funds Reservation Codes
                                      (example to http://hl7.org/fhir/ValueSet/fundsreserve)

                                      For whom funds are to be reserved: (Patient, Provider, None).

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      104. ExplanationOfBenefit.related
                                      Definition

                                      Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

                                      ShortPrior or corollary claims
                                      Comments

                                      If the current claim represents a claim that has been adjusted and was given a prior claim number, this field represents the prior claim number. If the current claim has been adjusted; i.e., replaced by or merged to another claim number, this data element represents that new number.(111, 112)

                                      Control0..*
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      For workplace or other accidents it is common to relate separate claims arising from the same event.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      106. ExplanationOfBenefit.related.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      108. ExplanationOfBenefit.related.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      110. ExplanationOfBenefit.related.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      112. ExplanationOfBenefit.related.claim
                                      Definition

                                      Reference to a related claim.

                                      ShortReference to the related claim
                                      Control0..1
                                      TypeReference(Claim)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      For workplace or other accidents it is common to relate separate claims arising from the same event.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      114. ExplanationOfBenefit.related.relationship
                                      Definition

                                      A code to convey how the claims are related.

                                      ShortHow the reference claim is related
                                      Comments

                                      For example, prior claim or umbrella.

                                      Control1..1
                                      BindingThe codes SHALL be taken from C4BB Related Claim Relationship Codes Value Set
                                      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      Some insurers need a declaration of the type of relationship.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      116. ExplanationOfBenefit.related.reference
                                      Definition

                                      An alternate organizational reference to the case or file to which this particular claim pertains.

                                      ShortFile or case reference
                                      Comments

                                      For example, Property/Casualty insurer claim number or Workers Compensation case number.

                                      Control1..1
                                      TypeIdentifier
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      118. ExplanationOfBenefit.prescription
                                      Definition

                                      Prescription to support the dispensing of pharmacy, device or vision products.

                                      ShortPrescription authorizing services or products
                                      Control0..1
                                      TypeReference(MedicationRequest, VisionPrescription)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Required to authorize the dispensing of controlled substances and devices.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      120. ExplanationOfBenefit.originalPrescription
                                      Definition

                                      Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

                                      ShortOriginal prescription if superceded by fulfiller
                                      Comments

                                      For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

                                      Control0..1
                                      TypeReference(MedicationRequest)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      122. ExplanationOfBenefit.payee
                                      Definition

                                      The party to be reimbursed for cost of the products and services according to the terms of the policy.

                                      ShortRecipient of benefits payable
                                      Comments

                                      Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead.

                                      Control0..1
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required (type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists())
                                      124. ExplanationOfBenefit.payee.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      126. ExplanationOfBenefit.payee.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      128. ExplanationOfBenefit.payee.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      130. ExplanationOfBenefit.payee.type
                                      Definition

                                      Type of Party to be reimbursed: Subscriber, provider, other.

                                      ShortCategory of recipient
                                      Comments

                                      Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120)

                                      Control1..1
                                      BindingThe codes SHALL be taken from C4BB Payee Type Value Set
                                      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      132. ExplanationOfBenefit.payee.party
                                      Definition

                                      Reference to the individual or organization to whom any payment will be made.

                                      ShortRecipient reference
                                      Comments

                                      Recipient reference (121)

                                      Control0..1
                                      TypeReference(C4BB Organization, C4BB Patient, C4BB Practitioner, C4BB RelatedPerson)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Must Support TypesNo must-support rules about the choice of types/profiles
                                      Summaryfalse
                                      Requirements

                                      Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      134. ExplanationOfBenefit.referral
                                      Definition

                                      A reference to a referral resource.

                                      ShortTreatment Referral
                                      Comments

                                      The referral resource which lists the date, practitioner, reason and other supporting information.

                                      Control0..1
                                      TypeReference(ServiceRequest)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Some insurers require proof of referral to pay for services or to pay specialist rates for services.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      136. ExplanationOfBenefit.facility
                                      Definition

                                      Facility where the services were provided.

                                      ShortServicing Facility
                                      Control0..1
                                      TypeReference(Location)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Insurance adjudication can be dependant on where services were delivered.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      138. ExplanationOfBenefit.claim
                                      Definition

                                      The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.

                                      ShortClaim reference
                                      Control0..1
                                      TypeReference(Claim)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      To provide a link to the original adjudication request.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      140. ExplanationOfBenefit.claimResponse
                                      Definition

                                      The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.

                                      ShortClaim response reference
                                      Control0..1
                                      TypeReference(ClaimResponse)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      To provide a link to the original adjudication response.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      142. ExplanationOfBenefit.outcome
                                      Definition

                                      The outcome of the claim, predetermination, or preauthorization processing.

                                      Shortqueued | complete | error | partial
                                      Comments

                                      Expected value is complete

                                      Control1..1
                                      BindingThe codes SHALL be taken from ClaimProcessingCodes
                                      (required to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1)

                                      The result of the claim processing.

                                      Typecode
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supporttrue
                                      Summarytrue
                                      Requirements

                                      To advise the requestor of an overall processing outcome.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      144. ExplanationOfBenefit.disposition
                                      Definition

                                      A human readable description of the status of the adjudication.

                                      ShortDisposition Message
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summaryfalse
                                      Requirements

                                      Provided for user display.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      146. ExplanationOfBenefit.preAuthRef
                                      Definition

                                      Reference from the Insurer which is used in later communications which refers to this adjudication.

                                      ShortPreauthorization reference
                                      Comments

                                      This value is only present on preauthorization adjudications.

                                      Control0..*
                                      Typestring
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summaryfalse
                                      Requirements

                                      On subsequent claims, the insurer may require the provider to quote this value.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      148. ExplanationOfBenefit.preAuthRefPeriod
                                      Definition

                                      The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.

                                      ShortPreauthorization in-effect period
                                      Comments

                                      This value is only present on preauthorization adjudications.

                                      Control0..*
                                      TypePeriod
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      On subsequent claims, the insurer may require the provider to quote this value.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      150. ExplanationOfBenefit.careTeam
                                      Definition

                                      The members of the team who provided the products and services.

                                      ShortCare Team members
                                      Control0..*
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      Common to identify the responsible and supporting practitioners.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner (( role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner) ))
                                      152. ExplanationOfBenefit.careTeam.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      154. ExplanationOfBenefit.careTeam.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      156. ExplanationOfBenefit.careTeam.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      158. ExplanationOfBenefit.careTeam.sequence
                                      Definition

                                      A number to uniquely identify care team entries.

                                      ShortOrder of care team
                                      Comments

                                      careTeam.sequence values uniquely identify careTeam members. They do not necessarily indicate any order in which the patient was seen by the careTeam or identify any level of significance of the careTeam to the patient, etc. Client app implementations should not assign any significance to the sequence values

                                      Control1..1
                                      TypepositiveInt
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summaryfalse
                                      Requirements

                                      Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      160. ExplanationOfBenefit.careTeam.provider
                                      Definition

                                      Member of the team who provided the product or service.

                                      ShortPractitioner or organization
                                      Comments

                                      The identifier assigned to the care team. (varies depending on the profile)

                                      Control1..1
                                      TypeReference(C4BB Organization, C4BB Practitioner)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Must Support TypesNo must-support rules about the choice of types/profiles
                                      Summaryfalse
                                      Requirements

                                      Often a regulatory requirement to specify the responsible provider.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      162. ExplanationOfBenefit.careTeam.responsible
                                      Definition

                                      The party who is billing and/or responsible for the claimed products or services.

                                      ShortIndicator of the lead practitioner
                                      Comments

                                      Responsible might not be required when there is only a single provider listed.

                                      Control0..1
                                      Typeboolean
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summaryfalse
                                      Requirements

                                      When multiple parties are present it is required to distinguish the lead or responsible individual.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      164. ExplanationOfBenefit.careTeam.role
                                      Definition

                                      The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

                                      ShortFunction within the team
                                      Comments

                                      The functional role of a provider on a claim. (165)

                                      Control1..1
                                      BindingThe codes SHALL be taken from C4BB Claim Professional And Non Clinician Care Team Role Value Set
                                      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianCareTeamRole)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      When multiple parties are present it is required to distinguish the roles performed by each member.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      166. ExplanationOfBenefit.careTeam.qualification
                                      Definition

                                      The qualification of the practitioner which is applicable for this service.

                                      ShortPractitioner credential or specialization
                                      Control0..1
                                      BindingThe codes SHALL be taken from Healthcare Provider Taxonomy .
                                      (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      Need to specify which qualification a provider is delivering the product or service under.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      168. ExplanationOfBenefit.supportingInfo
                                      Definition

                                      Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                      ShortSupporting information
                                      Comments

                                      Defines data elements not available in the base EOB resource

                                      Control0..*
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • pattern @ category
                                      • 170. ExplanationOfBenefit.supportingInfo.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        172. ExplanationOfBenefit.supportingInfo.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        174. ExplanationOfBenefit.supportingInfo.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                        ShortExtensions that cannot be ignored even if unrecognized
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                        Summarytrue
                                        Requirements

                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                        Alternate Namesextensions, user content, modifiers
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        176. ExplanationOfBenefit.supportingInfo.sequence
                                        Definition

                                        A number to uniquely identify supporting information entries.

                                        ShortInformation instance identifier
                                        Comments

                                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                        Control1..1
                                        TypepositiveInt
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Requirements

                                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        178. ExplanationOfBenefit.supportingInfo.category
                                        Definition

                                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                        ShortClassification of the supplied information
                                        Comments

                                        This may contain a category for the local bill type codes.

                                        Control1..1
                                        BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        180. ExplanationOfBenefit.supportingInfo.code
                                        Definition

                                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                        ShortType of information
                                        Comments

                                        This may contain the local bill type codes such as the US UB-04 bill type code.

                                        Control0..1
                                        BindingFor example codes, see ExceptionCodes
                                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                        The valuset used for additional information codes.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Required to identify the kind of additional information.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        182. ExplanationOfBenefit.supportingInfo.timing[x]
                                        Definition

                                        The date when or period to which this information refers.

                                        ShortWhen it occurred
                                        Control0..1
                                        TypeChoice of: date, Period
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        184. ExplanationOfBenefit.supportingInfo.value[x]
                                        Definition

                                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                        ShortData to be provided
                                        Comments

                                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                        Control0..1
                                        TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Requirements

                                        To convey the data content to be provided when the information is more than a simple code or period.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        186. ExplanationOfBenefit.supportingInfo.reason
                                        Definition

                                        Provides the reason in the situation where a reason code is required in addition to the content.

                                        ShortExplanation for the information
                                        Comments

                                        For example: the reason for the additional stay, or why a tooth is missing.

                                        Control0..1
                                        BindingFor example codes, see MissingToothReasonCodes
                                        (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                        Reason codes for the missing teeth.

                                        TypeCoding
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Needed when the supporting information has both a date and amount/value and requires explanation.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        188. ExplanationOfBenefit.supportingInfo:clmrecvddate
                                        Slice Nameclmrecvddate
                                        Definition

                                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                        ShortClaim received date
                                        Comments

                                        The date the claim was received by the payer (88)

                                        Control0..1
                                        TypeBackboneElement
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Requirements

                                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        190. ExplanationOfBenefit.supportingInfo:clmrecvddate.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        192. ExplanationOfBenefit.supportingInfo:clmrecvddate.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        194. ExplanationOfBenefit.supportingInfo:clmrecvddate.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                        ShortExtensions that cannot be ignored even if unrecognized
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                        Summarytrue
                                        Requirements

                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                        Alternate Namesextensions, user content, modifiers
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        196. ExplanationOfBenefit.supportingInfo:clmrecvddate.sequence
                                        Definition

                                        A number to uniquely identify supporting information entries.

                                        ShortInformation instance identifier
                                        Comments

                                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                        Control1..1
                                        TypepositiveInt
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Requirements

                                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        198. ExplanationOfBenefit.supportingInfo:clmrecvddate.category
                                        Definition

                                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                        ShortClassification of the supplied information
                                        Comments

                                        This may contain a category for the local bill type codes.

                                        Control1..1
                                        BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Requirements

                                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                        Pattern Value{
                                          "coding" : [{
                                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                            "code" : "clmrecvddate"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        200. ExplanationOfBenefit.supportingInfo:clmrecvddate.code
                                        Definition

                                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                        ShortType of information
                                        Comments

                                        This may contain the local bill type codes such as the US UB-04 bill type code.

                                        Control0..1
                                        BindingFor example codes, see ExceptionCodes
                                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                        The valuset used for additional information codes.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Required to identify the kind of additional information.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        202. ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x]
                                        Definition

                                        The date when or period to which this information refers.

                                        ShortWhen it occurred
                                        Control1..1
                                        Typedate
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        204. ExplanationOfBenefit.supportingInfo:clmrecvddate.value[x]
                                        Definition

                                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                        ShortData to be provided
                                        Comments

                                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                        Control0..1
                                        TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Requirements

                                        To convey the data content to be provided when the information is more than a simple code or period.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        206. ExplanationOfBenefit.supportingInfo:clmrecvddate.reason
                                        Definition

                                        Provides the reason in the situation where a reason code is required in addition to the content.

                                        ShortExplanation for the information
                                        Comments

                                        For example: the reason for the additional stay, or why a tooth is missing.

                                        Control0..1
                                        BindingFor example codes, see MissingToothReasonCodes
                                        (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                        Reason codes for the missing teeth.

                                        TypeCoding
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Needed when the supporting information has both a date and amount/value and requires explanation.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        208. ExplanationOfBenefit.supportingInfo:servicefacility
                                        Slice Nameservicefacility
                                        Definition

                                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                        ShortService facility
                                        Comments

                                        Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rndering Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA. If the service facility is not assigned an NPI, this data element will not be populated. Reference CMS 1500 element 32a (97, 170, 176)

                                        Control0..1
                                        TypeBackboneElement
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Requirements

                                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        210. ExplanationOfBenefit.supportingInfo:servicefacility.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        212. ExplanationOfBenefit.supportingInfo:servicefacility.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        214. ExplanationOfBenefit.supportingInfo:servicefacility.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                        ShortExtensions that cannot be ignored even if unrecognized
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                        Summarytrue
                                        Requirements

                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                        Alternate Namesextensions, user content, modifiers
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        216. ExplanationOfBenefit.supportingInfo:servicefacility.sequence
                                        Definition

                                        A number to uniquely identify supporting information entries.

                                        ShortInformation instance identifier
                                        Comments

                                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                        Control1..1
                                        TypepositiveInt
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Requirements

                                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        218. ExplanationOfBenefit.supportingInfo:servicefacility.category
                                        Definition

                                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                        ShortClassification of the supplied information
                                        Comments

                                        This may contain a category for the local bill type codes.

                                        Control1..1
                                        BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Requirements

                                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                        Pattern Value{
                                          "coding" : [{
                                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                            "code" : "servicefacility"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        220. ExplanationOfBenefit.supportingInfo:servicefacility.code
                                        Definition

                                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                        ShortType of information
                                        Comments

                                        This may contain the local bill type codes such as the US UB-04 bill type code.

                                        Control0..1
                                        BindingFor example codes, see ExceptionCodes
                                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                        The valuset used for additional information codes.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Required to identify the kind of additional information.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        222. ExplanationOfBenefit.supportingInfo:servicefacility.timing[x]
                                        Definition

                                        The date when or period to which this information refers.

                                        ShortWhen it occurred
                                        Control0..1
                                        TypeChoice of: date, Period
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        224. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]
                                        Definition

                                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                        ShortData to be provided
                                        Comments

                                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                        Control1..1
                                        TypeReference(Resource)
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        To convey the data content to be provided when the information is more than a simple code or period.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                        • type @ $this
                                        • 226. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]:valueReference
                                          Slice NamevalueReference
                                          Definition

                                          Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                          ShortData to be provided
                                          Comments

                                          Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                          Control1..1
                                          TypeReference(C4BB Organization)
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          To convey the data content to be provided when the information is more than a simple code or period.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          228. ExplanationOfBenefit.supportingInfo:servicefacility.reason
                                          Definition

                                          Provides the reason in the situation where a reason code is required in addition to the content.

                                          ShortExplanation for the information
                                          Comments

                                          For example: the reason for the additional stay, or why a tooth is missing.

                                          Control0..1
                                          BindingFor example codes, see MissingToothReasonCodes
                                          (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                          Reason codes for the missing teeth.

                                          TypeCoding
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Needed when the supporting information has both a date and amount/value and requires explanation.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          230. ExplanationOfBenefit.supportingInfo:medicalrecordnumber
                                          Slice Namemedicalrecordnumber
                                          Definition

                                          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                          ShortMedical record number
                                          Comments

                                          Provider submitted medical record number that can be included on the claim. (109)

                                          Control0..1
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          232. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          234. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          236. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          238. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.sequence
                                          Definition

                                          A number to uniquely identify supporting information entries.

                                          ShortInformation instance identifier
                                          Comments

                                          Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                          Control1..1
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          240. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.category
                                          Definition

                                          The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                          ShortClassification of the supplied information
                                          Comments

                                          This may contain a category for the local bill type codes.

                                          Control1..1
                                          BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                          (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                              "code" : "medicalrecordnumber"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          242. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.code
                                          Definition

                                          System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                          ShortType of information
                                          Comments

                                          This may contain the local bill type codes such as the US UB-04 bill type code.

                                          Control0..1
                                          BindingFor example codes, see ExceptionCodes
                                          (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                          The valuset used for additional information codes.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to identify the kind of additional information.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          244. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.timing[x]
                                          Definition

                                          The date when or period to which this information refers.

                                          ShortWhen it occurred
                                          Control0..1
                                          TypeChoice of: date, Period
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          246. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]
                                          Definition

                                          Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                          ShortData to be provided
                                          Comments

                                          Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                          Control1..1
                                          Typestring
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          To convey the data content to be provided when the information is more than a simple code or period.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                          • type @ $this
                                          • 248. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]:valueString
                                            Slice NamevalueString
                                            Definition

                                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                            ShortData to be provided
                                            Comments

                                            Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                            Control1..1
                                            Typestring
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            To convey the data content to be provided when the information is more than a simple code or period.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            250. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.reason
                                            Definition

                                            Provides the reason in the situation where a reason code is required in addition to the content.

                                            ShortExplanation for the information
                                            Comments

                                            For example: the reason for the additional stay, or why a tooth is missing.

                                            Control0..1
                                            BindingFor example codes, see MissingToothReasonCodes
                                            (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                            Reason codes for the missing teeth.

                                            TypeCoding
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Needed when the supporting information has both a date and amount/value and requires explanation.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            252. ExplanationOfBenefit.supportingInfo:patientaccountnumber
                                            Slice Namepatientaccountnumber
                                            Definition

                                            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                            ShortPatient account number
                                            Comments

                                            Provider assigned patient account number that can be included on the claim. (109)

                                            Control0..1
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            254. ExplanationOfBenefit.supportingInfo:patientaccountnumber.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            256. ExplanationOfBenefit.supportingInfo:patientaccountnumber.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            258. ExplanationOfBenefit.supportingInfo:patientaccountnumber.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            260. ExplanationOfBenefit.supportingInfo:patientaccountnumber.sequence
                                            Definition

                                            A number to uniquely identify supporting information entries.

                                            ShortInformation instance identifier
                                            Comments

                                            Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                            Control1..1
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            262. ExplanationOfBenefit.supportingInfo:patientaccountnumber.category
                                            Definition

                                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                            ShortClassification of the supplied information
                                            Comments

                                            This may contain a category for the local bill type codes.

                                            Control1..1
                                            BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                                "code" : "patientaccountnumber"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            264. ExplanationOfBenefit.supportingInfo:patientaccountnumber.code
                                            Definition

                                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                            ShortType of information
                                            Comments

                                            This may contain the local bill type codes such as the US UB-04 bill type code.

                                            Control0..1
                                            BindingFor example codes, see ExceptionCodes
                                            (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                            The valuset used for additional information codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Required to identify the kind of additional information.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            266. ExplanationOfBenefit.supportingInfo:patientaccountnumber.timing[x]
                                            Definition

                                            The date when or period to which this information refers.

                                            ShortWhen it occurred
                                            Control0..1
                                            TypeChoice of: date, Period
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            268. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]
                                            Definition

                                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                            ShortData to be provided
                                            Comments

                                            Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                            Control1..1
                                            Typestring
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            To convey the data content to be provided when the information is more than a simple code or period.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                            • type @ $this
                                            • 270. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]:valueString
                                              Slice NamevalueString
                                              Definition

                                              Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                              ShortData to be provided
                                              Comments

                                              Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                              Control1..1
                                              Typestring
                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supporttrue
                                              Summaryfalse
                                              Requirements

                                              To convey the data content to be provided when the information is more than a simple code or period.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              272. ExplanationOfBenefit.supportingInfo:patientaccountnumber.reason
                                              Definition

                                              Provides the reason in the situation where a reason code is required in addition to the content.

                                              ShortExplanation for the information
                                              Comments

                                              For example: the reason for the additional stay, or why a tooth is missing.

                                              Control0..1
                                              BindingFor example codes, see MissingToothReasonCodes
                                              (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                              Reason codes for the missing teeth.

                                              TypeCoding
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Needed when the supporting information has both a date and amount/value and requires explanation.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              274. ExplanationOfBenefit.supportingInfo:patientweight
                                              Slice Namepatientweight
                                              Definition

                                              Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                              ShortSupporting information
                                              Comments

                                              Defines data elements not available in the base EOB resource

                                              Control0..*
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Requirements

                                              Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              276. ExplanationOfBenefit.supportingInfo:patientweight.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              278. ExplanationOfBenefit.supportingInfo:patientweight.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              280. ExplanationOfBenefit.supportingInfo:patientweight.modifierExtension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                              ShortExtensions that cannot be ignored even if unrecognized
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                              Summarytrue
                                              Requirements

                                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                              Alternate Namesextensions, user content, modifiers
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              282. ExplanationOfBenefit.supportingInfo:patientweight.sequence
                                              Definition

                                              A number to uniquely identify supporting information entries.

                                              ShortInformation instance identifier
                                              Comments

                                              Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                              Control1..1
                                              TypepositiveInt
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summaryfalse
                                              Requirements

                                              Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              284. ExplanationOfBenefit.supportingInfo:patientweight.category
                                              Definition

                                              The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                              ShortClassification of the supplied information
                                              Comments

                                              This may contain a category for the local bill type codes.

                                              Control1..1
                                              BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                              (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                              Pattern Value{
                                                "coding" : [{
                                                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                                  "code" : "patientweight"
                                                }]
                                              }
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              286. ExplanationOfBenefit.supportingInfo:patientweight.code
                                              Definition

                                              System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                              ShortType of information
                                              Comments

                                              This may contain the local bill type codes such as the US UB-04 bill type code.

                                              Control0..0
                                              BindingFor example codes, see ExceptionCodes
                                              (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                              The valuset used for additional information codes.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Required to identify the kind of additional information.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              288. ExplanationOfBenefit.supportingInfo:patientweight.timing[x]
                                              Definition

                                              The date when or period to which this information refers.

                                              ShortWhen it occurred
                                              Control0..0
                                              TypeChoice of: date, Period
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              290. ExplanationOfBenefit.supportingInfo:patientweight.value[x]
                                              Definition

                                              Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                              ShortData to be provided
                                              Comments

                                              Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                              Control1..1
                                              TypeQuantity
                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              To convey the data content to be provided when the information is more than a simple code or period.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              292. ExplanationOfBenefit.supportingInfo:patientweight.value[x].id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              294. ExplanationOfBenefit.supportingInfo:patientweight.value[x].extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 296. ExplanationOfBenefit.supportingInfo:patientweight.value[x].value
                                                Definition

                                                The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                ShortNumerical value (with implicit precision)
                                                Comments

                                                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                Control1..1
                                                Typedecimal
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Precision is handled implicitly in almost all cases of measurement.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                298. ExplanationOfBenefit.supportingInfo:patientweight.value[x].comparator
                                                Definition

                                                How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                Short< | <= | >= | > - how to understand the value
                                                Control0..1
                                                BindingThe codes SHALL be taken from QuantityComparator
                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                How the Quantity should be understood and represented.

                                                Typecode
                                                Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                300. ExplanationOfBenefit.supportingInfo:patientweight.value[x].unit
                                                Definition

                                                A human-readable form of the unit.

                                                ShortUnit representation
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                Pattern Value[lb_av]
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                302. ExplanationOfBenefit.supportingInfo:patientweight.value[x].system
                                                Definition

                                                The identification of the system that provides the coded form of the unit.

                                                ShortSystem that defines coded unit form
                                                Control0..1
                                                This element is affected by the following invariants: qty-3
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need to know the system that defines the coded form of the unit.

                                                Pattern Valuehttp://unitsofmeasure.org
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                304. ExplanationOfBenefit.supportingInfo:patientweight.value[x].code
                                                Definition

                                                A computer processable form of the unit in some unit representation system.

                                                ShortCoded form of the unit
                                                Comments

                                                The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                Control0..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                306. ExplanationOfBenefit.supportingInfo:patientweight.reason
                                                Definition

                                                Provides the reason in the situation where a reason code is required in addition to the content.

                                                ShortExplanation for the information
                                                Comments

                                                For example: the reason for the additional stay, or why a tooth is missing.

                                                Control0..1
                                                BindingFor example codes, see MissingToothReasonCodes
                                                (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                                Reason codes for the missing teeth.

                                                TypeCoding
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed when the supporting information has both a date and amount/value and requires explanation.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                308. ExplanationOfBenefit.supportingInfo:ambulancetransportreason
                                                Slice Nameambulancetransportreason
                                                Definition

                                                Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                                ShortSupporting information
                                                Comments

                                                Defines data elements not available in the base EOB resource

                                                Control0..*
                                                TypeBackboneElement
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Requirements

                                                Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                310. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                312. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                314. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.modifierExtension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                ShortExtensions that cannot be ignored even if unrecognized
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                Requirements

                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                Alternate Namesextensions, user content, modifiers
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                316. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.sequence
                                                Definition

                                                A number to uniquely identify supporting information entries.

                                                ShortInformation instance identifier
                                                Comments

                                                Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                                Control1..1
                                                TypepositiveInt
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                318. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.category
                                                Definition

                                                The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                                ShortClassification of the supplied information
                                                Comments

                                                This may contain a category for the local bill type codes.

                                                Control1..1
                                                BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                                (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                                Pattern Value{
                                                  "coding" : [{
                                                    "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                                    "code" : "ambulancetransportreason"
                                                  }]
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                320. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.code
                                                Definition

                                                System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                                ShortType of information
                                                Comments

                                                This may contain the local bill type codes such as the US UB-04 bill type code.

                                                Control0..0
                                                BindingFor example codes, see ExceptionCodes
                                                (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                                The valuset used for additional information codes.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Required to identify the kind of additional information.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                322. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.timing[x]
                                                Definition

                                                The date when or period to which this information refers.

                                                ShortWhen it occurred
                                                Control0..0
                                                TypeChoice of: date, Period
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                324. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.value[x]
                                                Definition

                                                Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                ShortData to be provided
                                                Comments

                                                Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                                Control0..1
                                                TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                To convey the data content to be provided when the information is more than a simple code or period.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                326. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.reason
                                                Definition

                                                Provides the reason in the situation where a reason code is required in addition to the content.

                                                ShortExplanation for the information
                                                Comments

                                                For example: the reason for the additional stay, or why a tooth is missing.

                                                Control1..1
                                                BindingThe codes SHALL be taken from C4BB Ambulance Transport Reasons Value Set
                                                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAmbulanceTransportReasonCodes)
                                                TypeCoding
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed when the supporting information has both a date and amount/value and requires explanation.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                328. ExplanationOfBenefit.supportingInfo:transportationdistance
                                                Slice Nametransportationdistance
                                                Definition

                                                Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                                ShortSupporting information
                                                Comments

                                                Defines data elements not available in the base EOB resource

                                                Control0..*
                                                TypeBackboneElement
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Requirements

                                                Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                330. ExplanationOfBenefit.supportingInfo:transportationdistance.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                332. ExplanationOfBenefit.supportingInfo:transportationdistance.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                334. ExplanationOfBenefit.supportingInfo:transportationdistance.modifierExtension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                ShortExtensions that cannot be ignored even if unrecognized
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                Requirements

                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                Alternate Namesextensions, user content, modifiers
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                336. ExplanationOfBenefit.supportingInfo:transportationdistance.sequence
                                                Definition

                                                A number to uniquely identify supporting information entries.

                                                ShortInformation instance identifier
                                                Comments

                                                Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                                Control1..1
                                                TypepositiveInt
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                338. ExplanationOfBenefit.supportingInfo:transportationdistance.category
                                                Definition

                                                The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                                ShortClassification of the supplied information
                                                Comments

                                                This may contain a category for the local bill type codes.

                                                Control1..1
                                                BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                                (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                                Pattern Value{
                                                  "coding" : [{
                                                    "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                                    "code" : "transportationdistance"
                                                  }]
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                340. ExplanationOfBenefit.supportingInfo:transportationdistance.code
                                                Definition

                                                System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                                ShortType of information
                                                Comments

                                                This may contain the local bill type codes such as the US UB-04 bill type code.

                                                Control0..0
                                                BindingFor example codes, see ExceptionCodes
                                                (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                                The valuset used for additional information codes.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Required to identify the kind of additional information.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                342. ExplanationOfBenefit.supportingInfo:transportationdistance.timing[x]
                                                Definition

                                                The date when or period to which this information refers.

                                                ShortWhen it occurred
                                                Control0..0
                                                TypeChoice of: date, Period
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                344. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]
                                                Definition

                                                Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                ShortData to be provided
                                                Comments

                                                Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                                Control1..1
                                                TypeQuantity
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                To convey the data content to be provided when the information is more than a simple code or period.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                346. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                348. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 350. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].value
                                                  Definition

                                                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                  ShortNumerical value (with implicit precision)
                                                  Comments

                                                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                  Control1..1
                                                  Typedecimal
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Precision is handled implicitly in almost all cases of measurement.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  352. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].comparator
                                                  Definition

                                                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                  Short< | <= | >= | > - how to understand the value
                                                  Control0..1
                                                  BindingThe codes SHALL be taken from QuantityComparator
                                                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                  How the Quantity should be understood and represented.

                                                  Typecode
                                                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  354. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].unit
                                                  Definition

                                                  A human-readable form of the unit.

                                                  ShortUnit representation
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                  Pattern Value[mi_i]
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  356. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].system
                                                  Definition

                                                  The identification of the system that provides the coded form of the unit.

                                                  ShortSystem that defines coded unit form
                                                  Control0..1
                                                  This element is affected by the following invariants: qty-3
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Need to know the system that defines the coded form of the unit.

                                                  Pattern Valuehttp://unitsofmeasure.org
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  358. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].code
                                                  Definition

                                                  A computer processable form of the unit in some unit representation system.

                                                  ShortCoded form of the unit
                                                  Comments

                                                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                  Control0..1
                                                  Typecode
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  360. ExplanationOfBenefit.supportingInfo:transportationdistance.reason
                                                  Definition

                                                  Provides the reason in the situation where a reason code is required in addition to the content.

                                                  ShortExplanation for the information
                                                  Comments

                                                  For example: the reason for the additional stay, or why a tooth is missing.

                                                  Control0..1
                                                  BindingFor example codes, see MissingToothReasonCodes
                                                  (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                                  Reason codes for the missing teeth.

                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Needed when the supporting information has both a date and amount/value and requires explanation.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  362. ExplanationOfBenefit.supportingInfo:roudtrippurpose
                                                  Slice Nameroudtrippurpose
                                                  Definition

                                                  Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                                  ShortSupporting information
                                                  Comments

                                                  Defines data elements not available in the base EOB resource

                                                  Control0..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  364. ExplanationOfBenefit.supportingInfo:roudtrippurpose.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  366. ExplanationOfBenefit.supportingInfo:roudtrippurpose.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  368. ExplanationOfBenefit.supportingInfo:roudtrippurpose.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                  Summarytrue
                                                  Requirements

                                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                  Alternate Namesextensions, user content, modifiers
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  370. ExplanationOfBenefit.supportingInfo:roudtrippurpose.sequence
                                                  Definition

                                                  A number to uniquely identify supporting information entries.

                                                  ShortInformation instance identifier
                                                  Comments

                                                  Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                                  Control1..1
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  372. ExplanationOfBenefit.supportingInfo:roudtrippurpose.category
                                                  Definition

                                                  The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                                  ShortClassification of the supplied information
                                                  Comments

                                                  This may contain a category for the local bill type codes.

                                                  Control1..1
                                                  BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                                  (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                                  Pattern Value{
                                                    "coding" : [{
                                                      "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                                      "code" : "roudtrippurpose"
                                                    }]
                                                  }
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  374. ExplanationOfBenefit.supportingInfo:roudtrippurpose.code
                                                  Definition

                                                  System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                                  ShortType of information
                                                  Comments

                                                  This may contain the local bill type codes such as the US UB-04 bill type code.

                                                  Control0..0
                                                  BindingFor example codes, see ExceptionCodes
                                                  (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                                  The valuset used for additional information codes.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required to identify the kind of additional information.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  376. ExplanationOfBenefit.supportingInfo:roudtrippurpose.timing[x]
                                                  Definition

                                                  The date when or period to which this information refers.

                                                  ShortWhen it occurred
                                                  Control0..0
                                                  TypeChoice of: date, Period
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  378. ExplanationOfBenefit.supportingInfo:roudtrippurpose.value[x]
                                                  Definition

                                                  Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                  ShortData to be provided
                                                  Comments

                                                  Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                                  Control1..1
                                                  Typestring
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  To convey the data content to be provided when the information is more than a simple code or period.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  380. ExplanationOfBenefit.supportingInfo:roudtrippurpose.reason
                                                  Definition

                                                  Provides the reason in the situation where a reason code is required in addition to the content.

                                                  ShortExplanation for the information
                                                  Comments

                                                  For example: the reason for the additional stay, or why a tooth is missing.

                                                  Control0..1
                                                  BindingFor example codes, see MissingToothReasonCodes
                                                  (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                                  Reason codes for the missing teeth.

                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Needed when the supporting information has both a date and amount/value and requires explanation.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  382. ExplanationOfBenefit.supportingInfo:stretcherpurpose
                                                  Slice Namestretcherpurpose
                                                  Definition

                                                  Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                                  ShortSupporting information
                                                  Comments

                                                  Defines data elements not available in the base EOB resource

                                                  Control0..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  384. ExplanationOfBenefit.supportingInfo:stretcherpurpose.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  386. ExplanationOfBenefit.supportingInfo:stretcherpurpose.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  388. ExplanationOfBenefit.supportingInfo:stretcherpurpose.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                  Summarytrue
                                                  Requirements

                                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                  Alternate Namesextensions, user content, modifiers
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  390. ExplanationOfBenefit.supportingInfo:stretcherpurpose.sequence
                                                  Definition

                                                  A number to uniquely identify supporting information entries.

                                                  ShortInformation instance identifier
                                                  Comments

                                                  Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                                  Control1..1
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  392. ExplanationOfBenefit.supportingInfo:stretcherpurpose.category
                                                  Definition

                                                  The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                                  ShortClassification of the supplied information
                                                  Comments

                                                  This may contain a category for the local bill type codes.

                                                  Control1..1
                                                  BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                                  (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                                  Pattern Value{
                                                    "coding" : [{
                                                      "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                                      "code" : "stretcherpurpose"
                                                    }]
                                                  }
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  394. ExplanationOfBenefit.supportingInfo:stretcherpurpose.code
                                                  Definition

                                                  System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                                  ShortType of information
                                                  Comments

                                                  This may contain the local bill type codes such as the US UB-04 bill type code.

                                                  Control0..0
                                                  BindingFor example codes, see ExceptionCodes
                                                  (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                                  The valuset used for additional information codes.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required to identify the kind of additional information.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  396. ExplanationOfBenefit.supportingInfo:stretcherpurpose.timing[x]
                                                  Definition

                                                  The date when or period to which this information refers.

                                                  ShortWhen it occurred
                                                  Control0..0
                                                  TypeChoice of: date, Period
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  398. ExplanationOfBenefit.supportingInfo:stretcherpurpose.value[x]
                                                  Definition

                                                  Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                  ShortData to be provided
                                                  Comments

                                                  Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                                  Control1..1
                                                  Typestring
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  To convey the data content to be provided when the information is more than a simple code or period.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  400. ExplanationOfBenefit.supportingInfo:stretcherpurpose.reason
                                                  Definition

                                                  Provides the reason in the situation where a reason code is required in addition to the content.

                                                  ShortExplanation for the information
                                                  Comments

                                                  For example: the reason for the additional stay, or why a tooth is missing.

                                                  Control0..1
                                                  BindingFor example codes, see MissingToothReasonCodes
                                                  (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                                  Reason codes for the missing teeth.

                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Needed when the supporting information has both a date and amount/value and requires explanation.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  402. ExplanationOfBenefit.supportingInfo:pickuplocation
                                                  Slice Namepickuplocation
                                                  Definition

                                                  Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                                  ShortSupporting information
                                                  Comments

                                                  Defines data elements not available in the base EOB resource

                                                  Control0..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  404. ExplanationOfBenefit.supportingInfo:pickuplocation.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  406. ExplanationOfBenefit.supportingInfo:pickuplocation.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  408. ExplanationOfBenefit.supportingInfo:pickuplocation.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                  Summarytrue
                                                  Requirements

                                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                  Alternate Namesextensions, user content, modifiers
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  410. ExplanationOfBenefit.supportingInfo:pickuplocation.sequence
                                                  Definition

                                                  A number to uniquely identify supporting information entries.

                                                  ShortInformation instance identifier
                                                  Comments

                                                  Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                                  Control1..1
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  412. ExplanationOfBenefit.supportingInfo:pickuplocation.category
                                                  Definition

                                                  The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                                  ShortClassification of the supplied information
                                                  Comments

                                                  This may contain a category for the local bill type codes.

                                                  Control1..1
                                                  BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                                  (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                                  Pattern Value{
                                                    "coding" : [{
                                                      "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                                      "code" : "pickuplocation"
                                                    }]
                                                  }
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  414. ExplanationOfBenefit.supportingInfo:pickuplocation.code
                                                  Definition

                                                  System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                                  ShortType of information
                                                  Comments

                                                  This may contain the local bill type codes such as the US UB-04 bill type code.

                                                  Control0..0
                                                  BindingFor example codes, see ExceptionCodes
                                                  (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                                  The valuset used for additional information codes.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required to identify the kind of additional information.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  416. ExplanationOfBenefit.supportingInfo:pickuplocation.timing[x]
                                                  Definition

                                                  The date when or period to which this information refers.

                                                  ShortWhen it occurred
                                                  Control0..0
                                                  TypeChoice of: date, Period
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  418. ExplanationOfBenefit.supportingInfo:pickuplocation.value[x]
                                                  Definition

                                                  Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                  ShortData to be provided
                                                  Comments

                                                  Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                                  Control1..1
                                                  Typestring
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  To convey the data content to be provided when the information is more than a simple code or period.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  420. ExplanationOfBenefit.supportingInfo:pickuplocation.reason
                                                  Definition

                                                  Provides the reason in the situation where a reason code is required in addition to the content.

                                                  ShortExplanation for the information
                                                  Comments

                                                  For example: the reason for the additional stay, or why a tooth is missing.

                                                  Control0..1
                                                  BindingFor example codes, see MissingToothReasonCodes
                                                  (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                                  Reason codes for the missing teeth.

                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Needed when the supporting information has both a date and amount/value and requires explanation.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  422. ExplanationOfBenefit.supportingInfo:dropofflocation
                                                  Slice Namedropofflocation
                                                  Definition

                                                  Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                                  ShortSupporting information
                                                  Comments

                                                  Defines data elements not available in the base EOB resource

                                                  Control0..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  424. ExplanationOfBenefit.supportingInfo:dropofflocation.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  426. ExplanationOfBenefit.supportingInfo:dropofflocation.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  428. ExplanationOfBenefit.supportingInfo:dropofflocation.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                  Summarytrue
                                                  Requirements

                                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                  Alternate Namesextensions, user content, modifiers
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  430. ExplanationOfBenefit.supportingInfo:dropofflocation.sequence
                                                  Definition

                                                  A number to uniquely identify supporting information entries.

                                                  ShortInformation instance identifier
                                                  Comments

                                                  Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                                  Control1..1
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  432. ExplanationOfBenefit.supportingInfo:dropofflocation.category
                                                  Definition

                                                  The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                                  ShortClassification of the supplied information
                                                  Comments

                                                  This may contain a category for the local bill type codes.

                                                  Control1..1
                                                  BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                                  (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                                  Pattern Value{
                                                    "coding" : [{
                                                      "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                                      "code" : "dropofflocation"
                                                    }]
                                                  }
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  434. ExplanationOfBenefit.supportingInfo:dropofflocation.code
                                                  Definition

                                                  System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                                  ShortType of information
                                                  Comments

                                                  This may contain the local bill type codes such as the US UB-04 bill type code.

                                                  Control0..0
                                                  BindingFor example codes, see ExceptionCodes
                                                  (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                                  The valuset used for additional information codes.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required to identify the kind of additional information.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  436. ExplanationOfBenefit.supportingInfo:dropofflocation.timing[x]
                                                  Definition

                                                  The date when or period to which this information refers.

                                                  ShortWhen it occurred
                                                  Control0..0
                                                  TypeChoice of: date, Period
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  438. ExplanationOfBenefit.supportingInfo:dropofflocation.value[x]
                                                  Definition

                                                  Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                  ShortData to be provided
                                                  Comments

                                                  Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                                  Control1..1
                                                  Typestring
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  To convey the data content to be provided when the information is more than a simple code or period.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  440. ExplanationOfBenefit.supportingInfo:dropofflocation.reason
                                                  Definition

                                                  Provides the reason in the situation where a reason code is required in addition to the content.

                                                  ShortExplanation for the information
                                                  Comments

                                                  For example: the reason for the additional stay, or why a tooth is missing.

                                                  Control0..1
                                                  BindingFor example codes, see MissingToothReasonCodes
                                                  (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                                  Reason codes for the missing teeth.

                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Needed when the supporting information has both a date and amount/value and requires explanation.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  442. ExplanationOfBenefit.diagnosis
                                                  Definition

                                                  Information about diagnoses relevant to the claim items.

                                                  ShortPertinent diagnosis information
                                                  Comments

                                                  Diagnosis codes describe an individual's disease or medical condition. (6, 7, 8, 21, 22, 23, 30)

                                                  Control1..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Required for the adjudication by provided context for the services and product listed.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  444. ExplanationOfBenefit.diagnosis.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  446. ExplanationOfBenefit.diagnosis.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  448. ExplanationOfBenefit.diagnosis.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                  Summarytrue
                                                  Requirements

                                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                  Alternate Namesextensions, user content, modifiers
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  450. ExplanationOfBenefit.diagnosis.sequence
                                                  Definition

                                                  A number to uniquely identify diagnosis entries.

                                                  ShortDiagnosis instance identifier
                                                  Comments

                                                  Diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. client app implementations should not assign any significance to the sequence values. client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.

                                                  Control1..1
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  452. ExplanationOfBenefit.diagnosis.diagnosis[x]
                                                  Definition

                                                  The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                                  ShortNature of illness or problem
                                                  Control1..1
                                                  BindingThe codes SHALL be taken from Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set
                                                  (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CDCICD910CMDiagnosisCodes)
                                                  TypeCodeableConcept
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Provides health context for the evaluation of the products and/or services.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  454. ExplanationOfBenefit.diagnosis.type
                                                  Definition

                                                  When the condition was observed or the relative ranking.

                                                  ShortTiming or nature of the diagnosis
                                                  Comments

                                                  Indicates if the professional and non-clinician diagnosis is principal or secondary (21, 22, 23)

                                                  Control1..1
                                                  BindingThe codes SHALL be taken from C4BB Claim Professional And Non Clinician Diagnosis Type Value Set
                                                  (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianDiagnosisType)
                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Often required to capture a particular diagnosis, for example: primary or discharge.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  456. ExplanationOfBenefit.diagnosis.onAdmission
                                                  Definition

                                                  Indication of whether the diagnosis was present on admission to a facility.

                                                  ShortPresent on admission
                                                  Control0..1
                                                  BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                                  (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                                  Present on admission.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  458. ExplanationOfBenefit.diagnosis.packageCode
                                                  Definition

                                                  A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

                                                  ShortPackage billing code
                                                  Comments

                                                  For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

                                                  Control0..1
                                                  BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                                  (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                                  The DRG codes associated with the diagnosis.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  460. ExplanationOfBenefit.procedure
                                                  Definition

                                                  Procedures performed on the patient relevant to the billing items with the claim.

                                                  ShortClinical procedures performed
                                                  Control0..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  462. ExplanationOfBenefit.procedure.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  464. ExplanationOfBenefit.procedure.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  466. ExplanationOfBenefit.procedure.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                  Summarytrue
                                                  Requirements

                                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                  Alternate Namesextensions, user content, modifiers
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  468. ExplanationOfBenefit.procedure.sequence
                                                  Definition

                                                  A number to uniquely identify procedure entries.

                                                  ShortProcedure instance identifier
                                                  Control1..1
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Necessary to provide a mechanism to link to claim details.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  470. ExplanationOfBenefit.procedure.type
                                                  Definition

                                                  When the condition was observed or the relative ranking.

                                                  ShortCategory of Procedure
                                                  Control0..*
                                                  BindingFor example codes, see ExampleProcedureTypeCodes
                                                  (example to http://hl7.org/fhir/ValueSet/ex-procedure-type)

                                                  Example procedure type codes.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Often required to capture a particular diagnosis, for example: primary or discharge.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  472. ExplanationOfBenefit.procedure.date
                                                  Definition

                                                  Date and optionally time the procedure was performed.

                                                  ShortWhen the procedure was performed
                                                  Control0..1
                                                  TypedateTime
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Required for auditing purposes.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  474. ExplanationOfBenefit.procedure.procedure[x]
                                                  Definition

                                                  The code or reference to a Procedure resource which identifies the clinical intervention performed.

                                                  ShortSpecific clinical procedure
                                                  Control1..1
                                                  BindingFor example codes, see ICD-10ProcedureCodes
                                                  (example to http://hl7.org/fhir/ValueSet/icd-10-procedures)

                                                  ICD10 Procedure codes.

                                                  TypeChoice of: CodeableConcept, Reference(Procedure)
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  This identifies the actual clinical procedure.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  476. ExplanationOfBenefit.procedure.udi
                                                  Definition

                                                  Unique Device Identifiers associated with this line item.

                                                  ShortUnique device identifier
                                                  Control0..*
                                                  TypeReference(Device)
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  The UDI code allows the insurer to obtain device level information on the product supplied.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  478. ExplanationOfBenefit.precedence
                                                  Definition

                                                  This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.

                                                  ShortPrecedence (primary, secondary, etc.)
                                                  Control0..1
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Needed to coordinate between multiple EOBs for the same suite of services.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  480. ExplanationOfBenefit.insurance
                                                  Definition

                                                  Financial instruments for reimbursement for the health care products and services specified on the claim.

                                                  ShortPatient insurance information
                                                  Comments

                                                  Identity of the payers responsible for the claim. (2, 141). All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'

                                                  Control1..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  At least one insurer is required for a claim to be a claim.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  EOB-insurance-focal: EOB.insurance: at most one with focal = true (select (focal = true).count() < 2)
                                                  482. ExplanationOfBenefit.insurance.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  484. ExplanationOfBenefit.insurance.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  486. ExplanationOfBenefit.insurance.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                  Summarytrue
                                                  Requirements

                                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                  Alternate Namesextensions, user content, modifiers
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  488. ExplanationOfBenefit.insurance.focal
                                                  Definition

                                                  A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

                                                  ShortCoverage to be used for adjudication
                                                  Comments

                                                  A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'

                                                  Control1..1
                                                  Typeboolean
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  To identify which coverage in the list is being used to adjudicate this claim.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  490. ExplanationOfBenefit.insurance.coverage
                                                  Definition

                                                  Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

                                                  ShortInsurance information
                                                  Comments

                                                  Same as insurance.coverage.organization. Party responsible for reimbursing the provider. When focal = true, Coverage.payer--> Organization.identifier. When focal = false, EOB.insurance.coverage.display = [name of other carrier]

                                                  Control1..1
                                                  TypeReference(C4BB Coverage)
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  Required to allow the adjudicator to locate the correct policy and history within their information system.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  492. ExplanationOfBenefit.insurance.preAuthRef
                                                  Definition

                                                  Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.

                                                  ShortPrior authorization reference number
                                                  Comments

                                                  This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.

                                                  Control0..*
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  494. ExplanationOfBenefit.accident
                                                  Definition

                                                  Details of a accident which resulted in injuries which required the products and services listed in the claim.

                                                  ShortDetails of the event
                                                  Control0..1
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  496. ExplanationOfBenefit.accident.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  498. ExplanationOfBenefit.accident.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  500. ExplanationOfBenefit.accident.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                  Summarytrue
                                                  Requirements

                                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                  Alternate Namesextensions, user content, modifiers
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  502. ExplanationOfBenefit.accident.date
                                                  Definition

                                                  Date of an accident event related to the products and services contained in the claim.

                                                  ShortWhen the incident occurred
                                                  Comments

                                                  The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.

                                                  Control0..1
                                                  Typedate
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Required for audit purposes and adjudication.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  504. ExplanationOfBenefit.accident.type
                                                  Definition

                                                  The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.

                                                  ShortThe nature of the accident
                                                  Control0..1
                                                  BindingUnless not suitable, these codes SHALL be taken from ActIncidentCode
                                                  (extensible to http://terminology.hl7.org/ValueSet/v3-ActIncidentCode)

                                                  Type of accident: work place, auto, etc.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Coverage may be dependant on the type of accident.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  506. ExplanationOfBenefit.accident.location[x]
                                                  Definition

                                                  The physical location of the accident event.

                                                  ShortWhere the event occurred
                                                  Control0..1
                                                  TypeChoice of: Address, Reference(Location)
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required for audit purposes and determination of applicable insurance liability.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  508. ExplanationOfBenefit.item
                                                  Definition

                                                  A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.

                                                  ShortProduct or service provided
                                                  Control1..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  The items to be processed for adjudication.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  510. ExplanationOfBenefit.item.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  512. ExplanationOfBenefit.item.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  514. ExplanationOfBenefit.item.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                  Summarytrue
                                                  Requirements

                                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                  Alternate Namesextensions, user content, modifiers
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  516. ExplanationOfBenefit.item.sequence
                                                  Definition

                                                  A number to uniquely identify item entries.

                                                  ShortItem instance identifier
                                                  Comments

                                                  Line identification number that represents the number assigned in a source system for identification and processing. (36)

                                                  Control1..1
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  518. ExplanationOfBenefit.item.careTeamSequence
                                                  Definition

                                                  Care team members related to this service or product.

                                                  ShortApplicable care team members
                                                  Control0..*
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Need to identify the individuals and their roles in the provision of the product or service.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  520. ExplanationOfBenefit.item.diagnosisSequence
                                                  Definition

                                                  Diagnoses applicable for this service or product.

                                                  ShortApplicable diagnoses
                                                  Control0..*
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Need to related the product or service to the associated diagnoses.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  522. ExplanationOfBenefit.item.procedureSequence
                                                  Definition

                                                  Procedures applicable for this service or product.

                                                  ShortApplicable procedures
                                                  Control0..*
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Need to provide any listed specific procedures to support the product or service being claimed.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  524. ExplanationOfBenefit.item.informationSequence
                                                  Definition

                                                  Exceptions, special conditions and supporting information applicable for this service or product.

                                                  ShortApplicable exception and supporting information
                                                  Control0..*
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Need to reference the supporting information items that relate directly to this product or service.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  526. ExplanationOfBenefit.item.revenue
                                                  Definition

                                                  The type of revenue or cost center providing the product and/or service.

                                                  ShortRevenue or cost center code
                                                  Control0..1
                                                  BindingFor example codes, see ExampleRevenueCenterCodes
                                                  (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                                  Codes for the revenue or cost centers supplying the service and/or products.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Needed in the processing of institutional claims.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  528. ExplanationOfBenefit.item.category
                                                  Definition

                                                  Code to identify the general type of benefits under which products and services are provided.

                                                  ShortBenefit classification
                                                  Comments

                                                  Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                                  Control0..1
                                                  BindingFor example codes, see BenefitCategoryCodes
                                                  (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                                  Benefit categories such as: oral, medical, vision, oral-basic etc.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  530. ExplanationOfBenefit.item.productOrService
                                                  Definition

                                                  When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                                  ShortBilling, service, product, or drug code
                                                  Comments

                                                  Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40)

                                                  Control1..1
                                                  BindingThe codes SHALL be taken from Procedure Codes - AMA CPT - CMS HCPCS Value Set
                                                  (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSProcedureCodes)
                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Necessary to state what was provided or done.

                                                  Alternate NamesDrug Code, Bill Code, Service Code
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  532. ExplanationOfBenefit.item.modifier
                                                  Definition

                                                  Item typification or modifiers codes to convey additional context for the product or service.

                                                  ShortProduct or service billing modifiers
                                                  Comments

                                                  Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41)

                                                  Control0..*
                                                  BindingThe codes SHALL be taken from Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set
                                                  (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers)
                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  To support inclusion of the item for adjudication or to charge an elevated fee.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  534. ExplanationOfBenefit.item.programCode
                                                  Definition

                                                  Identifies the program under which this may be recovered.

                                                  ShortProgram the product or service is provided under
                                                  Comments

                                                  For example: Neonatal program, child dental program or drug users recovery program.

                                                  Control0..*
                                                  BindingFor example codes, see ExampleProgramReasonCodes
                                                  (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                                  Program specific reason codes.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  536. ExplanationOfBenefit.item.serviced[x]
                                                  Definition

                                                  The date or dates when the service or product was supplied, performed or completed.

                                                  ShortDate or dates of service or product delivery
                                                  Comments

                                                  Date services began/ended. Located on CMS 1500 (Form Locator 24A) (118)

                                                  Control1..1
                                                  TypeChoice of: date, Period
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  Needed to determine whether the service or product was provided during the term of the insurance coverage.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  538. ExplanationOfBenefit.item.location[x]
                                                  Definition

                                                  Where the product or service was provided.

                                                  ShortPlace of service or where product was supplied
                                                  Comments

                                                  Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed. (46)

                                                  Control1..1
                                                  BindingThe codes SHALL be taken from CMS Place of Service Codes (POS) Value Set
                                                  (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CMSPlaceofServiceCodes)
                                                  TypeCodeableConcept
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  540. ExplanationOfBenefit.item.quantity
                                                  Definition

                                                  The number of repetitions of a service or product.

                                                  ShortCount of products or services
                                                  Comments

                                                  The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code or CPT procedure code, submitted by the provider. (42)

                                                  Control0..1
                                                  TypeQuantity(SimpleQuantity)
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Required when the product or service code does not convey the quantity provided.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  542. ExplanationOfBenefit.item.unitPrice
                                                  Definition

                                                  If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                                  ShortFee, charge or cost per item
                                                  Control0..1
                                                  TypeMoney
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  The amount charged to the patient by the provider for a single unit.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  544. ExplanationOfBenefit.item.factor
                                                  Definition

                                                  A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                                  ShortPrice scaling factor
                                                  Comments

                                                  To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                                  Control0..1
                                                  Typedecimal
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Requirements

                                                  When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  546. ExplanationOfBenefit.item.net
                                                  Definition

                                                  The quantity times the unit price for an additional service or product or charge.

                                                  ShortTotal item cost
                                                  Comments

                                                  For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                                  Control0..1
                                                  TypeMoney
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Provides the total amount claimed for the group (if a grouper) or the line item.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  548. ExplanationOfBenefit.item.udi
                                                  Definition

                                                  Unique Device Identifiers associated with this line item.

                                                  ShortUnique device identifier
                                                  Control0..*
                                                  TypeReference(Device)
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  The UDI code allows the insurer to obtain device level information on the product supplied.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  550. ExplanationOfBenefit.item.bodySite
                                                  Definition

                                                  Physical service site on the patient (limb, tooth, etc.).

                                                  ShortAnatomical location
                                                  Comments

                                                  For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

                                                  Control0..1
                                                  BindingFor example codes, see OralSiteCodes
                                                  (example to http://hl7.org/fhir/ValueSet/tooth)

                                                  The code for the teeth, quadrant, sextant and arch.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Allows insurer to validate specific procedures.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  552. ExplanationOfBenefit.item.subSite
                                                  Definition

                                                  A region or surface of the bodySite, e.g. limb region or tooth surface(s).

                                                  ShortAnatomical sub-location
                                                  Control0..*
                                                  BindingFor example codes, see SurfaceCodes
                                                  (example to http://hl7.org/fhir/ValueSet/surface)

                                                  The code for the tooth surface and surface combinations.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Allows insurer to validate specific procedures.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  554. ExplanationOfBenefit.item.encounter
                                                  Definition

                                                  A billed item may include goods or services provided in multiple encounters.

                                                  ShortEncounters related to this billed item
                                                  Control0..*
                                                  TypeReference(Encounter)
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Used in some jurisdictions to link clinical events to claim items.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  556. ExplanationOfBenefit.item.noteNumber
                                                  Definition

                                                  The numbers associated with notes below which apply to the adjudication of this item.

                                                  ShortApplicable note numbers
                                                  Comments

                                                  References number of the associated processNote entered

                                                  Control0..*
                                                  TypepositiveInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  558. ExplanationOfBenefit.item.adjudication
                                                  Definition

                                                  If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                                                  ShortAdjudication details
                                                  Control1..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Requirements

                                                  The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  SlicingThis element introduces a set of slices on ExplanationOfBenefit.item.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • pattern @ category
                                                  • 560. ExplanationOfBenefit.item.adjudication.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    562. ExplanationOfBenefit.item.adjudication.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    564. ExplanationOfBenefit.item.adjudication.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    566. ExplanationOfBenefit.item.adjudication.category
                                                    Definition

                                                    A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                    ShortType of adjudication information
                                                    Comments

                                                    For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                    Control1..1
                                                    BindingUnless not suitable, these codes SHALL be taken from C4BB Adjudication Category Discriminator Value Set
                                                    (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    Needed to enable understanding of the context of the other information in the adjudication.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    568. ExplanationOfBenefit.item.adjudication.reason
                                                    Definition

                                                    A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                                    ShortExplanation of adjudication outcome
                                                    Comments

                                                    For example, may indicate that the funds for this benefit type have been exhausted.

                                                    Control0..1
                                                    BindingFor example codes, see AdjudicationReasonCodes
                                                    (example to http://hl7.org/fhir/ValueSet/adjudication-reason)

                                                    Adjudication reason codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    To support understanding of variance from adjudication expectations.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    570. ExplanationOfBenefit.item.adjudication.amount
                                                    Definition

                                                    Monetary amount associated with the category.

                                                    ShortMonetary amount
                                                    Comments

                                                    For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Most adjuciation categories convey a monetary amount.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    572. ExplanationOfBenefit.item.adjudication.value
                                                    Definition

                                                    A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                                    ShortNon-monitary value
                                                    Comments

                                                    For example: eligible percentage or co-payment percentage.

                                                    Control0..1
                                                    Typedecimal
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Some adjudication categories convey a percentage or a fixed value.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    574. ExplanationOfBenefit.item.adjudication:adjustmentreason
                                                    Slice Nameadjustmentreason
                                                    Definition

                                                    If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                                                    ShortReason codes used to interpret the Non-Covered Amount (92)
                                                    Comments

                                                    Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)

                                                    Control0..1
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    576. ExplanationOfBenefit.item.adjudication:adjustmentreason.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    578. ExplanationOfBenefit.item.adjudication:adjustmentreason.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    580. ExplanationOfBenefit.item.adjudication:adjustmentreason.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    582. ExplanationOfBenefit.item.adjudication:adjustmentreason.category
                                                    Definition

                                                    A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                    ShortType of adjudication information
                                                    Comments

                                                    For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                    Control1..1
                                                    BindingFor example codes, see AdjudicationValueCodes
                                                    (example to http://hl7.org/fhir/ValueSet/adjudication)

                                                    The adjudication codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    Needed to enable understanding of the context of the other information in the adjudication.

                                                    Pattern Value{
                                                      "coding" : [{
                                                        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                        "code" : "adjustmentreason"
                                                      }]
                                                    }
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    584. ExplanationOfBenefit.item.adjudication:adjustmentreason.reason
                                                    Definition

                                                    A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                                    ShortExplanation of adjudication outcome
                                                    Comments

                                                    For example, may indicate that the funds for this benefit type have been exhausted.

                                                    Control1..1
                                                    BindingThe codes SHALL be taken from X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set
                                                    (required to http://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes)
                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    To support understanding of variance from adjudication expectations.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    586. ExplanationOfBenefit.item.adjudication:adjustmentreason.amount
                                                    Definition

                                                    Monetary amount associated with the category.

                                                    ShortMonetary amount
                                                    Comments

                                                    For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Most adjuciation categories convey a monetary amount.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    588. ExplanationOfBenefit.item.adjudication:adjustmentreason.value
                                                    Definition

                                                    A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                                    ShortNon-monitary value
                                                    Comments

                                                    For example: eligible percentage or co-payment percentage.

                                                    Control0..1
                                                    Typedecimal
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Some adjudication categories convey a percentage or a fixed value.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    590. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus
                                                    Slice Namebenefitpaymentstatus
                                                    Definition

                                                    If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                                                    ShortIndicates the in network or out of network payment status of the claim. (142)
                                                    Comments

                                                    Indicates the in network or out of network payment status of the claim. (142)

                                                    Control1..1
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    592. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    594. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    596. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    598. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.category
                                                    Definition

                                                    A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                    ShortType of adjudication information
                                                    Comments

                                                    For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                    Control1..1
                                                    BindingFor example codes, see AdjudicationValueCodes
                                                    (example to http://hl7.org/fhir/ValueSet/adjudication)

                                                    The adjudication codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    Needed to enable understanding of the context of the other information in the adjudication.

                                                    Pattern Value{
                                                      "coding" : [{
                                                        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                        "code" : "benefitpaymentstatus"
                                                      }]
                                                    }
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    600. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.reason
                                                    Definition

                                                    A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                                    ShortExplanation of adjudication outcome
                                                    Comments

                                                    For example, may indicate that the funds for this benefit type have been exhausted.

                                                    Control1..1
                                                    BindingThe codes SHALL be taken from C4BB Payer Benefit Payment Status Value Set
                                                    (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerBenefitPaymentStatus)
                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    To support understanding of variance from adjudication expectations.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    602. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.amount
                                                    Definition

                                                    Monetary amount associated with the category.

                                                    ShortMonetary amount
                                                    Comments

                                                    For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Most adjuciation categories convey a monetary amount.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    604. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.value
                                                    Definition

                                                    A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                                    ShortNon-monitary value
                                                    Comments

                                                    For example: eligible percentage or co-payment percentage.

                                                    Control0..1
                                                    Typedecimal
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Some adjudication categories convey a percentage or a fixed value.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    606. ExplanationOfBenefit.item.adjudication:allowedunits
                                                    Slice Nameallowedunits
                                                    Definition

                                                    If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                                                    ShortThe quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)
                                                    Comments

                                                    The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)

                                                    Control0..1
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    608. ExplanationOfBenefit.item.adjudication:allowedunits.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    610. ExplanationOfBenefit.item.adjudication:allowedunits.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    612. ExplanationOfBenefit.item.adjudication:allowedunits.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    614. ExplanationOfBenefit.item.adjudication:allowedunits.category
                                                    Definition

                                                    A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                    ShortType of adjudication information
                                                    Comments

                                                    For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                    Control1..1
                                                    BindingFor example codes, see AdjudicationValueCodes
                                                    (example to http://hl7.org/fhir/ValueSet/adjudication)

                                                    The adjudication codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    Needed to enable understanding of the context of the other information in the adjudication.

                                                    Pattern Value{
                                                      "coding" : [{
                                                        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                        "code" : "allowedunits"
                                                      }]
                                                    }
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    616. ExplanationOfBenefit.item.adjudication:allowedunits.reason
                                                    Definition

                                                    A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                                    ShortExplanation of adjudication outcome
                                                    Comments

                                                    For example, may indicate that the funds for this benefit type have been exhausted.

                                                    Control0..1
                                                    BindingFor example codes, see AdjudicationReasonCodes
                                                    (example to http://hl7.org/fhir/ValueSet/adjudication-reason)

                                                    Adjudication reason codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    To support understanding of variance from adjudication expectations.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    618. ExplanationOfBenefit.item.adjudication:allowedunits.amount
                                                    Definition

                                                    Monetary amount associated with the category.

                                                    ShortMonetary amount
                                                    Comments

                                                    For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Most adjuciation categories convey a monetary amount.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    620. ExplanationOfBenefit.item.adjudication:allowedunits.value
                                                    Definition

                                                    A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                                    ShortNon-monitary value
                                                    Comments

                                                    For example: eligible percentage or co-payment percentage.

                                                    Control0..1
                                                    Typedecimal
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Some adjudication categories convey a percentage or a fixed value.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    622. ExplanationOfBenefit.item.detail
                                                    Definition

                                                    Second-tier of goods and services.

                                                    ShortAdditional items
                                                    Control0..*
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    624. ExplanationOfBenefit.item.detail.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    626. ExplanationOfBenefit.item.detail.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    628. ExplanationOfBenefit.item.detail.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    630. ExplanationOfBenefit.item.detail.sequence
                                                    Definition

                                                    A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                                                    ShortProduct or service provided
                                                    Control1..1
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    The items to be processed for adjudication.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    632. ExplanationOfBenefit.item.detail.revenue
                                                    Definition

                                                    The type of revenue or cost center providing the product and/or service.

                                                    ShortRevenue or cost center code
                                                    Control0..1
                                                    BindingFor example codes, see ExampleRevenueCenterCodes
                                                    (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                                    Codes for the revenue or cost centers supplying the service and/or products.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Needed in the processing of institutional claims.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    634. ExplanationOfBenefit.item.detail.category
                                                    Definition

                                                    Code to identify the general type of benefits under which products and services are provided.

                                                    ShortBenefit classification
                                                    Comments

                                                    Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                                    Control0..1
                                                    BindingFor example codes, see BenefitCategoryCodes
                                                    (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                                    Benefit categories such as: oral, medical, vision, oral-basic etc.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    636. ExplanationOfBenefit.item.detail.productOrService
                                                    Definition

                                                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                                    ShortBilling, service, product, or drug code
                                                    Comments

                                                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                                    Control1..1
                                                    BindingFor example codes, see USCLSCodes
                                                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                                    Allowable service and product codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Necessary to state what was provided or done.

                                                    Alternate NamesDrug Code, Bill Code, Service Code
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    638. ExplanationOfBenefit.item.detail.modifier
                                                    Definition

                                                    Item typification or modifiers codes to convey additional context for the product or service.

                                                    ShortService/Product billing modifiers
                                                    Comments

                                                    For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                                    Control0..*
                                                    BindingFor example codes, see ModifierTypeCodes
                                                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    To support inclusion of the item for adjudication or to charge an elevated fee.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    640. ExplanationOfBenefit.item.detail.programCode
                                                    Definition

                                                    Identifies the program under which this may be recovered.

                                                    ShortProgram the product or service is provided under
                                                    Comments

                                                    For example: Neonatal program, child dental program or drug users recovery program.

                                                    Control0..*
                                                    BindingFor example codes, see ExampleProgramReasonCodes
                                                    (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                                    Program specific reason codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    642. ExplanationOfBenefit.item.detail.quantity
                                                    Definition

                                                    The number of repetitions of a service or product.

                                                    ShortCount of products or services
                                                    Control0..1
                                                    TypeQuantity(SimpleQuantity)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Required when the product or service code does not convey the quantity provided.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    644. ExplanationOfBenefit.item.detail.unitPrice
                                                    Definition

                                                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                                    ShortFee, charge or cost per item
                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    The amount charged to the patient by the provider for a single unit.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    646. ExplanationOfBenefit.item.detail.factor
                                                    Definition

                                                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                                    ShortPrice scaling factor
                                                    Comments

                                                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                                    Control0..1
                                                    Typedecimal
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    648. ExplanationOfBenefit.item.detail.net
                                                    Definition

                                                    The quantity times the unit price for an additional service or product or charge.

                                                    ShortTotal item cost
                                                    Comments

                                                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Provides the total amount claimed for the group (if a grouper) or the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    650. ExplanationOfBenefit.item.detail.udi
                                                    Definition

                                                    Unique Device Identifiers associated with this line item.

                                                    ShortUnique device identifier
                                                    Control0..*
                                                    TypeReference(Device)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    The UDI code allows the insurer to obtain device level information on the product supplied.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    652. ExplanationOfBenefit.item.detail.noteNumber
                                                    Definition

                                                    The numbers associated with notes below which apply to the adjudication of this item.

                                                    ShortApplicable note numbers
                                                    Control0..*
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    654. ExplanationOfBenefit.item.detail.adjudication
                                                    Definition

                                                    The adjudication results.

                                                    ShortDetail level adjudication details
                                                    Control0..*
                                                    TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    656. ExplanationOfBenefit.item.detail.subDetail
                                                    Definition

                                                    Third-tier of goods and services.

                                                    ShortAdditional items
                                                    Control0..*
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    658. ExplanationOfBenefit.item.detail.subDetail.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    660. ExplanationOfBenefit.item.detail.subDetail.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    662. ExplanationOfBenefit.item.detail.subDetail.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    664. ExplanationOfBenefit.item.detail.subDetail.sequence
                                                    Definition

                                                    A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                                                    ShortProduct or service provided
                                                    Control1..1
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    The items to be processed for adjudication.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    666. ExplanationOfBenefit.item.detail.subDetail.revenue
                                                    Definition

                                                    The type of revenue or cost center providing the product and/or service.

                                                    ShortRevenue or cost center code
                                                    Control0..1
                                                    BindingFor example codes, see ExampleRevenueCenterCodes
                                                    (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                                    Codes for the revenue or cost centers supplying the service and/or products.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Needed in the processing of institutional claims.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    668. ExplanationOfBenefit.item.detail.subDetail.category
                                                    Definition

                                                    Code to identify the general type of benefits under which products and services are provided.

                                                    ShortBenefit classification
                                                    Comments

                                                    Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                                    Control0..1
                                                    BindingFor example codes, see BenefitCategoryCodes
                                                    (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                                    Benefit categories such as: oral, medical, vision, oral-basic etc.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    670. ExplanationOfBenefit.item.detail.subDetail.productOrService
                                                    Definition

                                                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                                    ShortBilling, service, product, or drug code
                                                    Comments

                                                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                                    Control1..1
                                                    BindingFor example codes, see USCLSCodes
                                                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                                    Allowable service and product codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Necessary to state what was provided or done.

                                                    Alternate NamesDrug Code, Bill Code, Service Code
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    672. ExplanationOfBenefit.item.detail.subDetail.modifier
                                                    Definition

                                                    Item typification or modifiers codes to convey additional context for the product or service.

                                                    ShortService/Product billing modifiers
                                                    Comments

                                                    For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

                                                    Control0..*
                                                    BindingFor example codes, see ModifierTypeCodes
                                                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    To support inclusion of the item for adjudication or to charge an elevated fee.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    674. ExplanationOfBenefit.item.detail.subDetail.programCode
                                                    Definition

                                                    Identifies the program under which this may be recovered.

                                                    ShortProgram the product or service is provided under
                                                    Comments

                                                    For example: Neonatal program, child dental program or drug users recovery program.

                                                    Control0..*
                                                    BindingFor example codes, see ExampleProgramReasonCodes
                                                    (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                                    Program specific reason codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    676. ExplanationOfBenefit.item.detail.subDetail.quantity
                                                    Definition

                                                    The number of repetitions of a service or product.

                                                    ShortCount of products or services
                                                    Control0..1
                                                    TypeQuantity(SimpleQuantity)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Required when the product or service code does not convey the quantity provided.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    678. ExplanationOfBenefit.item.detail.subDetail.unitPrice
                                                    Definition

                                                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                                    ShortFee, charge or cost per item
                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    The amount charged to the patient by the provider for a single unit.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    680. ExplanationOfBenefit.item.detail.subDetail.factor
                                                    Definition

                                                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                                    ShortPrice scaling factor
                                                    Comments

                                                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                                    Control0..1
                                                    Typedecimal
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    682. ExplanationOfBenefit.item.detail.subDetail.net
                                                    Definition

                                                    The quantity times the unit price for an additional service or product or charge.

                                                    ShortTotal item cost
                                                    Comments

                                                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Provides the total amount claimed for the group (if a grouper) or the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    684. ExplanationOfBenefit.item.detail.subDetail.udi
                                                    Definition

                                                    Unique Device Identifiers associated with this line item.

                                                    ShortUnique device identifier
                                                    Control0..*
                                                    TypeReference(Device)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    The UDI code allows the insurer to obtain device level information on the product supplied.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    686. ExplanationOfBenefit.item.detail.subDetail.noteNumber
                                                    Definition

                                                    The numbers associated with notes below which apply to the adjudication of this item.

                                                    ShortApplicable note numbers
                                                    Control0..*
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    688. ExplanationOfBenefit.item.detail.subDetail.adjudication
                                                    Definition

                                                    The adjudication results.

                                                    ShortSubdetail level adjudication details
                                                    Control0..*
                                                    TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    690. ExplanationOfBenefit.addItem
                                                    Definition

                                                    The first-tier service adjudications for payor added product or service lines.

                                                    ShortInsurer added line items
                                                    Control0..*
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    692. ExplanationOfBenefit.addItem.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    694. ExplanationOfBenefit.addItem.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    696. ExplanationOfBenefit.addItem.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    698. ExplanationOfBenefit.addItem.itemSequence
                                                    Definition

                                                    Claim items which this service line is intended to replace.

                                                    ShortItem sequence number
                                                    Control0..*
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Provides references to the claim items.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    700. ExplanationOfBenefit.addItem.detailSequence
                                                    Definition

                                                    The sequence number of the details within the claim item which this line is intended to replace.

                                                    ShortDetail sequence number
                                                    Control0..*
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Provides references to the claim details within the claim item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    702. ExplanationOfBenefit.addItem.subDetailSequence
                                                    Definition

                                                    The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace.

                                                    ShortSubdetail sequence number
                                                    Control0..*
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Provides references to the claim sub-details within the claim detail.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    704. ExplanationOfBenefit.addItem.provider
                                                    Definition

                                                    The providers who are authorized for the services rendered to the patient.

                                                    ShortAuthorized providers
                                                    Control0..*
                                                    TypeReference(Practitioner, PractitionerRole, Organization)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    706. ExplanationOfBenefit.addItem.productOrService
                                                    Definition

                                                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                                    ShortBilling, service, product, or drug code
                                                    Comments

                                                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                                    Control1..1
                                                    BindingFor example codes, see USCLSCodes
                                                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                                    Allowable service and product codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Necessary to state what was provided or done.

                                                    Alternate NamesDrug Code, Bill Code, Service Code
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    708. ExplanationOfBenefit.addItem.modifier
                                                    Definition

                                                    Item typification or modifiers codes to convey additional context for the product or service.

                                                    ShortService/Product billing modifiers
                                                    Comments

                                                    For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                                    Control0..*
                                                    BindingFor example codes, see ModifierTypeCodes
                                                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    To support inclusion of the item for adjudication or to charge an elevated fee.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    710. ExplanationOfBenefit.addItem.programCode
                                                    Definition

                                                    Identifies the program under which this may be recovered.

                                                    ShortProgram the product or service is provided under
                                                    Comments

                                                    For example: Neonatal program, child dental program or drug users recovery program.

                                                    Control0..*
                                                    BindingFor example codes, see ExampleProgramReasonCodes
                                                    (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                                    Program specific reason codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    712. ExplanationOfBenefit.addItem.serviced[x]
                                                    Definition

                                                    The date or dates when the service or product was supplied, performed or completed.

                                                    ShortDate or dates of service or product delivery
                                                    Control0..1
                                                    TypeChoice of: date, Period
                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Needed to determine whether the service or product was provided during the term of the insurance coverage.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    714. ExplanationOfBenefit.addItem.location[x]
                                                    Definition

                                                    Where the product or service was provided.

                                                    ShortPlace of service or where product was supplied
                                                    Control0..1
                                                    BindingFor example codes, see ExampleServicePlaceCodes
                                                    (example to http://hl7.org/fhir/ValueSet/service-place)

                                                    Place where the service is rendered.

                                                    TypeChoice of: CodeableConcept, Address, Reference(Location)
                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    716. ExplanationOfBenefit.addItem.quantity
                                                    Definition

                                                    The number of repetitions of a service or product.

                                                    ShortCount of products or services
                                                    Control0..1
                                                    TypeQuantity(SimpleQuantity)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Required when the product or service code does not convey the quantity provided.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    718. ExplanationOfBenefit.addItem.unitPrice
                                                    Definition

                                                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                                    ShortFee, charge or cost per item
                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    The amount charged to the patient by the provider for a single unit.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    720. ExplanationOfBenefit.addItem.factor
                                                    Definition

                                                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                                    ShortPrice scaling factor
                                                    Comments

                                                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                                    Control0..1
                                                    Typedecimal
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    722. ExplanationOfBenefit.addItem.net
                                                    Definition

                                                    The quantity times the unit price for an additional service or product or charge.

                                                    ShortTotal item cost
                                                    Comments

                                                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Provides the total amount claimed for the group (if a grouper) or the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    724. ExplanationOfBenefit.addItem.bodySite
                                                    Definition

                                                    Physical service site on the patient (limb, tooth, etc.).

                                                    ShortAnatomical location
                                                    Comments

                                                    For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

                                                    Control0..1
                                                    BindingFor example codes, see OralSiteCodes
                                                    (example to http://hl7.org/fhir/ValueSet/tooth)

                                                    The code for the teeth, quadrant, sextant and arch.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Allows insurer to validate specific procedures.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    726. ExplanationOfBenefit.addItem.subSite
                                                    Definition

                                                    A region or surface of the bodySite, e.g. limb region or tooth surface(s).

                                                    ShortAnatomical sub-location
                                                    Control0..*
                                                    BindingFor example codes, see SurfaceCodes
                                                    (example to http://hl7.org/fhir/ValueSet/surface)

                                                    The code for the tooth surface and surface combinations.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Allows insurer to validate specific procedures.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    728. ExplanationOfBenefit.addItem.noteNumber
                                                    Definition

                                                    The numbers associated with notes below which apply to the adjudication of this item.

                                                    ShortApplicable note numbers
                                                    Control0..*
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    730. ExplanationOfBenefit.addItem.adjudication
                                                    Definition

                                                    The adjudication results.

                                                    ShortAdded items adjudication
                                                    Control0..*
                                                    TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    732. ExplanationOfBenefit.addItem.detail
                                                    Definition

                                                    The second-tier service adjudications for payor added services.

                                                    ShortInsurer added line items
                                                    Control0..*
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    734. ExplanationOfBenefit.addItem.detail.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    736. ExplanationOfBenefit.addItem.detail.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    738. ExplanationOfBenefit.addItem.detail.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    740. ExplanationOfBenefit.addItem.detail.productOrService
                                                    Definition

                                                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                                    ShortBilling, service, product, or drug code
                                                    Comments

                                                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                                    Control1..1
                                                    BindingFor example codes, see USCLSCodes
                                                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                                    Allowable service and product codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Necessary to state what was provided or done.

                                                    Alternate NamesDrug Code, Bill Code, Service Code
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    742. ExplanationOfBenefit.addItem.detail.modifier
                                                    Definition

                                                    Item typification or modifiers codes to convey additional context for the product or service.

                                                    ShortService/Product billing modifiers
                                                    Comments

                                                    For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                                    Control0..*
                                                    BindingFor example codes, see ModifierTypeCodes
                                                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    To support inclusion of the item for adjudication or to charge an elevated fee.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    744. ExplanationOfBenefit.addItem.detail.quantity
                                                    Definition

                                                    The number of repetitions of a service or product.

                                                    ShortCount of products or services
                                                    Control0..1
                                                    TypeQuantity(SimpleQuantity)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Required when the product or service code does not convey the quantity provided.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    746. ExplanationOfBenefit.addItem.detail.unitPrice
                                                    Definition

                                                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                                    ShortFee, charge or cost per item
                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    The amount charged to the patient by the provider for a single unit.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    748. ExplanationOfBenefit.addItem.detail.factor
                                                    Definition

                                                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                                    ShortPrice scaling factor
                                                    Comments

                                                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                                    Control0..1
                                                    Typedecimal
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    750. ExplanationOfBenefit.addItem.detail.net
                                                    Definition

                                                    The quantity times the unit price for an additional service or product or charge.

                                                    ShortTotal item cost
                                                    Comments

                                                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Provides the total amount claimed for the group (if a grouper) or the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    752. ExplanationOfBenefit.addItem.detail.noteNumber
                                                    Definition

                                                    The numbers associated with notes below which apply to the adjudication of this item.

                                                    ShortApplicable note numbers
                                                    Control0..*
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    754. ExplanationOfBenefit.addItem.detail.adjudication
                                                    Definition

                                                    The adjudication results.

                                                    ShortAdded items adjudication
                                                    Control0..*
                                                    TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    756. ExplanationOfBenefit.addItem.detail.subDetail
                                                    Definition

                                                    The third-tier service adjudications for payor added services.

                                                    ShortInsurer added line items
                                                    Control0..*
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    758. ExplanationOfBenefit.addItem.detail.subDetail.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    760. ExplanationOfBenefit.addItem.detail.subDetail.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    762. ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    764. ExplanationOfBenefit.addItem.detail.subDetail.productOrService
                                                    Definition

                                                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                                    ShortBilling, service, product, or drug code
                                                    Comments

                                                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                                    Control1..1
                                                    BindingFor example codes, see USCLSCodes
                                                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                                    Allowable service and product codes.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Necessary to state what was provided or done.

                                                    Alternate NamesDrug Code, Bill Code, Service Code
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    766. ExplanationOfBenefit.addItem.detail.subDetail.modifier
                                                    Definition

                                                    Item typification or modifiers codes to convey additional context for the product or service.

                                                    ShortService/Product billing modifiers
                                                    Comments

                                                    For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                                    Control0..*
                                                    BindingFor example codes, see ModifierTypeCodes
                                                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    To support inclusion of the item for adjudication or to charge an elevated fee.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    768. ExplanationOfBenefit.addItem.detail.subDetail.quantity
                                                    Definition

                                                    The number of repetitions of a service or product.

                                                    ShortCount of products or services
                                                    Control0..1
                                                    TypeQuantity(SimpleQuantity)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Required when the product or service code does not convey the quantity provided.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    770. ExplanationOfBenefit.addItem.detail.subDetail.unitPrice
                                                    Definition

                                                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                                    ShortFee, charge or cost per item
                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    The amount charged to the patient by the provider for a single unit.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    772. ExplanationOfBenefit.addItem.detail.subDetail.factor
                                                    Definition

                                                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                                    ShortPrice scaling factor
                                                    Comments

                                                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                                    Control0..1
                                                    Typedecimal
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    774. ExplanationOfBenefit.addItem.detail.subDetail.net
                                                    Definition

                                                    The quantity times the unit price for an additional service or product or charge.

                                                    ShortTotal item cost
                                                    Comments

                                                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                                    Control0..1
                                                    TypeMoney
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Provides the total amount claimed for the group (if a grouper) or the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    776. ExplanationOfBenefit.addItem.detail.subDetail.noteNumber
                                                    Definition

                                                    The numbers associated with notes below which apply to the adjudication of this item.

                                                    ShortApplicable note numbers
                                                    Control0..*
                                                    TypepositiveInt
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summaryfalse
                                                    Requirements

                                                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    778. ExplanationOfBenefit.addItem.detail.subDetail.adjudication
                                                    Definition

                                                    The adjudication results.

                                                    ShortAdded items adjudication
                                                    Control0..*
                                                    TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    780. ExplanationOfBenefit.adjudication
                                                    Definition

                                                    The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                                                    ShortHeader-level adjudication
                                                    Control0..*
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Requirements

                                                    Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    SlicingThis element introduces a set of slices on ExplanationOfBenefit.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • pattern @ category
                                                    • 782. ExplanationOfBenefit.adjudication.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      784. ExplanationOfBenefit.adjudication.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      786. ExplanationOfBenefit.adjudication.modifierExtension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      788. ExplanationOfBenefit.adjudication.category
                                                      Definition

                                                      A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                      ShortType of adjudication information
                                                      Comments

                                                      For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                      Control1..1
                                                      BindingUnless not suitable, these codes SHALL be taken from C4BB Adjudication Category Discriminator Value Set
                                                      (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to enable understanding of the context of the other information in the adjudication.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      790. ExplanationOfBenefit.adjudication.reason
                                                      Definition

                                                      A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                                      ShortExplanation of adjudication outcome
                                                      Comments

                                                      For example, may indicate that the funds for this benefit type have been exhausted.

                                                      Control0..1
                                                      BindingFor example codes, see AdjudicationReasonCodes
                                                      (example to http://hl7.org/fhir/ValueSet/adjudication-reason)

                                                      Adjudication reason codes.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      To support understanding of variance from adjudication expectations.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      792. ExplanationOfBenefit.adjudication.amount
                                                      Definition

                                                      Monetary amount associated with the category.

                                                      ShortMonetary amount
                                                      Comments

                                                      For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                                      Control0..1
                                                      TypeMoney
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Most adjuciation categories convey a monetary amount.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      794. ExplanationOfBenefit.adjudication.value
                                                      Definition

                                                      A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                                      ShortNon-monitary value
                                                      Comments

                                                      For example: eligible percentage or co-payment percentage.

                                                      Control0..1
                                                      Typedecimal
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Some adjudication categories convey a percentage or a fixed value.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      796. ExplanationOfBenefit.adjudication:billingnetworkstatus
                                                      Slice Namebillingnetworkstatus
                                                      Definition

                                                      The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                                                      ShortBilling provider networking status
                                                      Comments

                                                      Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101)

                                                      Control0..1
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      798. ExplanationOfBenefit.adjudication:billingnetworkstatus.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      800. ExplanationOfBenefit.adjudication:billingnetworkstatus.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      802. ExplanationOfBenefit.adjudication:billingnetworkstatus.modifierExtension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      804. ExplanationOfBenefit.adjudication:billingnetworkstatus.category
                                                      Definition

                                                      A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                      ShortType of adjudication information
                                                      Comments

                                                      For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                      Control1..1
                                                      BindingFor example codes, see AdjudicationValueCodes
                                                      (example to http://hl7.org/fhir/ValueSet/adjudication)

                                                      The adjudication codes.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to enable understanding of the context of the other information in the adjudication.

                                                      Pattern Value{
                                                        "coding" : [{
                                                          "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                          "code" : "billingnetworkstatus"
                                                        }]
                                                      }
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      806. ExplanationOfBenefit.adjudication:billingnetworkstatus.reason
                                                      Definition

                                                      A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                                      ShortExplanation of adjudication outcome
                                                      Comments

                                                      For example, may indicate that the funds for this benefit type have been exhausted.

                                                      Control1..1
                                                      BindingThe codes SHALL be taken from C4BB Payer Provider Network Status Value Set
                                                      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus)
                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      To support understanding of variance from adjudication expectations.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      808. ExplanationOfBenefit.adjudication:billingnetworkstatus.amount
                                                      Definition

                                                      Monetary amount associated with the category.

                                                      ShortMonetary amount
                                                      Comments

                                                      For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                                      Control0..1
                                                      TypeMoney
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Most adjuciation categories convey a monetary amount.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      810. ExplanationOfBenefit.adjudication:billingnetworkstatus.value
                                                      Definition

                                                      A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                                      ShortNon-monitary value
                                                      Comments

                                                      For example: eligible percentage or co-payment percentage.

                                                      Control0..1
                                                      Typedecimal
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Some adjudication categories convey a percentage or a fixed value.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      812. ExplanationOfBenefit.adjudication:renderingnetworkstatus
                                                      Slice Namerenderingnetworkstatus
                                                      Definition

                                                      The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                                                      ShortRendering provider networking status
                                                      Comments

                                                      Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission. (101)

                                                      Control0..1
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      814. ExplanationOfBenefit.adjudication:renderingnetworkstatus.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      816. ExplanationOfBenefit.adjudication:renderingnetworkstatus.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      818. ExplanationOfBenefit.adjudication:renderingnetworkstatus.modifierExtension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      820. ExplanationOfBenefit.adjudication:renderingnetworkstatus.category
                                                      Definition

                                                      A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                      ShortType of adjudication information
                                                      Comments

                                                      For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                      Control1..1
                                                      BindingFor example codes, see AdjudicationValueCodes
                                                      (example to http://hl7.org/fhir/ValueSet/adjudication)

                                                      The adjudication codes.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to enable understanding of the context of the other information in the adjudication.

                                                      Pattern Value{
                                                        "coding" : [{
                                                          "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                          "code" : "renderingnetworkstatus"
                                                        }]
                                                      }
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      822. ExplanationOfBenefit.adjudication:renderingnetworkstatus.reason
                                                      Definition

                                                      A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                                      ShortExplanation of adjudication outcome
                                                      Comments

                                                      For example, may indicate that the funds for this benefit type have been exhausted.

                                                      Control1..1
                                                      BindingThe codes SHALL be taken from C4BB Payer Provider Network Status Value Set
                                                      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus)
                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      To support understanding of variance from adjudication expectations.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      824. ExplanationOfBenefit.adjudication:renderingnetworkstatus.amount
                                                      Definition

                                                      Monetary amount associated with the category.

                                                      ShortMonetary amount
                                                      Comments

                                                      For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                                      Control0..1
                                                      TypeMoney
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Most adjuciation categories convey a monetary amount.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      826. ExplanationOfBenefit.adjudication:renderingnetworkstatus.value
                                                      Definition

                                                      A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                                      ShortNon-monitary value
                                                      Comments

                                                      For example: eligible percentage or co-payment percentage.

                                                      Control0..1
                                                      Typedecimal
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Some adjudication categories convey a percentage or a fixed value.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      828. ExplanationOfBenefit.total
                                                      Definition

                                                      Categorized monetary totals for the adjudication.

                                                      ShortAdjudication totals
                                                      Comments

                                                      Totals for amounts submitted, co-pays, benefits payable etc.

                                                      Control0..*
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Requirements

                                                      To provide the requestor with financial totals by category for the adjudication.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      830. ExplanationOfBenefit.total.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      832. ExplanationOfBenefit.total.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      834. ExplanationOfBenefit.total.modifierExtension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      836. ExplanationOfBenefit.total.category
                                                      Definition

                                                      A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                      ShortType of adjudication information
                                                      Comments

                                                      For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                      Control1..1
                                                      BindingFor example codes, see AdjudicationValueCodes
                                                      (example to http://hl7.org/fhir/ValueSet/adjudication)

                                                      The adjudication codes.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Requirements

                                                      Needed to convey the type of total provided.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      838. ExplanationOfBenefit.total.amount
                                                      Definition

                                                      Monetary total amount associated with the category.

                                                      ShortFinancial total for the category
                                                      Control1..1
                                                      TypeMoney
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Requirements

                                                      Needed to convey the total monetary amount.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      840. ExplanationOfBenefit.payment
                                                      Definition

                                                      Payment details for the adjudication of the claim.

                                                      ShortPayment Details
                                                      Control0..1
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to convey references to the financial instrument that has been used if payment has been made.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      842. ExplanationOfBenefit.payment.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      844. ExplanationOfBenefit.payment.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      846. ExplanationOfBenefit.payment.modifierExtension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      848. ExplanationOfBenefit.payment.type
                                                      Definition

                                                      Whether this represents partial or complete payment of the benefits payable.

                                                      ShortPartial or complete payment
                                                      Comments

                                                      Indicates whether the claim was paid or denied. (91)

                                                      Control0..1
                                                      BindingThe codes SHALL be taken from C4BB Payer Claim Payment Status Code Value Set
                                                      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode)
                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      To advise the requestor when the insurer believes all payments to have been completed.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      850. ExplanationOfBenefit.payment.adjustment
                                                      Definition

                                                      Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.

                                                      ShortPayment adjustment for non-claim issues
                                                      Comments

                                                      Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.

                                                      Control0..1
                                                      TypeMoney
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      To advise the requestor of adjustments applied to the payment.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      852. ExplanationOfBenefit.payment.adjustmentReason
                                                      Definition

                                                      Reason for the payment adjustment.

                                                      ShortExplanation for the variance
                                                      Control0..1
                                                      BindingFor example codes, see PaymentAdjustmentReasonCodes
                                                      (example to http://hl7.org/fhir/ValueSet/payment-adjustment-reason)

                                                      Payment Adjustment reason codes.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to clarify the monetary adjustment.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      854. ExplanationOfBenefit.payment.date
                                                      Definition

                                                      Estimated date the payment will be issued or the actual issue date of payment.

                                                      ShortExpected date of payment
                                                      Comments

                                                      The date the claim was paid. (107)

                                                      Control0..1
                                                      Typedate
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      To advise the payee when payment can be expected.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      856. ExplanationOfBenefit.payment.amount
                                                      Definition

                                                      Benefits payable less any payment adjustment.

                                                      ShortPayable amount after adjustment
                                                      Control0..1
                                                      TypeMoney
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to provide the actual payment amount.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      858. ExplanationOfBenefit.payment.identifier
                                                      Definition

                                                      Issuer's unique identifier for the payment instrument.

                                                      ShortBusiness identifier for the payment
                                                      Comments

                                                      For example: EFT number or check number.

                                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                                      Control0..1
                                                      TypeIdentifier
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Enable the receiver to reconcile when payment received.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      860. ExplanationOfBenefit.formCode
                                                      Definition

                                                      A code for the form to be used for printing the content.

                                                      ShortPrinted form identifier
                                                      Comments

                                                      May be needed to identify specific jurisdictional forms.

                                                      Control0..1
                                                      BindingFor example codes, see Form Codes
                                                      (example to http://hl7.org/fhir/ValueSet/forms)

                                                      The forms codes.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to specify the specific form used for producing output for this response.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      862. ExplanationOfBenefit.form
                                                      Definition

                                                      The actual form, by reference or inclusion, for printing the content or an EOB.

                                                      ShortPrinted reference or actual form
                                                      Comments

                                                      Needed to permit insurers to include the actual form.

                                                      Control0..1
                                                      TypeAttachment
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to include the specific form used for producing output for this response.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      864. ExplanationOfBenefit.processNote
                                                      Definition

                                                      A note that describes or explains adjudication results in a human readable form.

                                                      ShortNote concerning adjudication
                                                      Control0..*
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      Provides the insurer specific textual explanations associated with the processing.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      866. ExplanationOfBenefit.processNote.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      868. ExplanationOfBenefit.processNote.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      870. ExplanationOfBenefit.processNote.modifierExtension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      872. ExplanationOfBenefit.processNote.number
                                                      Definition

                                                      A number to uniquely identify a note entry.

                                                      ShortNote instance identifier
                                                      Control0..1
                                                      TypepositiveInt
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Necessary to provide a mechanism to link from adjudications.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      874. ExplanationOfBenefit.processNote.type
                                                      Definition

                                                      The business purpose of the note text.

                                                      Shortdisplay | print | printoper
                                                      Control0..1
                                                      BindingThe codes SHALL be taken from NoteType
                                                      (required to http://hl7.org/fhir/ValueSet/note-type|4.0.1)

                                                      The presentation types of notes.

                                                      Typecode
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      To convey the expectation for when the text is used.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      876. ExplanationOfBenefit.processNote.text
                                                      Definition

                                                      The explanation or description associated with the processing.

                                                      ShortNote explanatory text
                                                      Comments

                                                      Payment denial explanation to a member, typically goes on the EOB when the payment is denied or disallowed (181)

                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Required to provide human readable explanation.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      878. ExplanationOfBenefit.processNote.language
                                                      Definition

                                                      A code to define the language used in the text of the note.

                                                      ShortLanguage of the text
                                                      Comments

                                                      Only required if the language is different from the resource language.

                                                      Control0..1
                                                      BindingThe codes SHOULD be taken from CommonLanguages
                                                      (preferred to http://hl7.org/fhir/ValueSet/languages)

                                                      A human language.

                                                      Additional BindingsPurpose
                                                      AllLanguagesMax Binding
                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Note text may vary from the resource defined language.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      880. ExplanationOfBenefit.benefitPeriod
                                                      Definition

                                                      The term of the benefits documented in this response.

                                                      ShortWhen the benefits are applicable
                                                      Comments

                                                      Not applicable when use=claim.

                                                      Control0..1
                                                      TypePeriod
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      882. ExplanationOfBenefit.benefitBalance
                                                      Definition

                                                      Balance by Benefit Category.

                                                      ShortBalance by Benefit Category
                                                      Control0..*
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      884. ExplanationOfBenefit.benefitBalance.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      886. ExplanationOfBenefit.benefitBalance.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      888. ExplanationOfBenefit.benefitBalance.modifierExtension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      890. ExplanationOfBenefit.benefitBalance.category
                                                      Definition

                                                      Code to identify the general type of benefits under which products and services are provided.

                                                      ShortBenefit classification
                                                      Comments

                                                      Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                                      Control1..1
                                                      BindingFor example codes, see BenefitCategoryCodes
                                                      (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                                      Benefit categories such as: oral, medical, vision, oral-basic etc.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to convey the category of service or product for which eligibility is sought.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      892. ExplanationOfBenefit.benefitBalance.excluded
                                                      Definition

                                                      True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.

                                                      ShortExcluded from the plan
                                                      Control0..1
                                                      Typeboolean
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to identify items that are specifically excluded from the coverage.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      894. ExplanationOfBenefit.benefitBalance.name
                                                      Definition

                                                      A short name or tag for the benefit.

                                                      ShortShort name for the benefit
                                                      Comments

                                                      For example: MED01, or DENT2.

                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Required to align with other plan names.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      896. ExplanationOfBenefit.benefitBalance.description
                                                      Definition

                                                      A richer description of the benefit or services covered.

                                                      ShortDescription of the benefit or services covered
                                                      Comments

                                                      For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.

                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Needed for human readable reference.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      898. ExplanationOfBenefit.benefitBalance.network
                                                      Definition

                                                      Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.

                                                      ShortIn or out of network
                                                      Control0..1
                                                      BindingFor example codes, see NetworkTypeCodes
                                                      (example to http://hl7.org/fhir/ValueSet/benefit-network)

                                                      Code to classify in or out of network services.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed as in or out of network providers are treated differently under the coverage.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      900. ExplanationOfBenefit.benefitBalance.unit
                                                      Definition

                                                      Indicates if the benefits apply to an individual or to the family.

                                                      ShortIndividual or family
                                                      Control0..1
                                                      BindingFor example codes, see UnitTypeCodes
                                                      (example to http://hl7.org/fhir/ValueSet/benefit-unit)

                                                      Unit covered/serviced - individual or family.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed for the understanding of the benefits.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      902. ExplanationOfBenefit.benefitBalance.term
                                                      Definition

                                                      The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.

                                                      ShortAnnual or lifetime
                                                      Control0..1
                                                      BindingFor example codes, see BenefitTermCodes
                                                      (example to http://hl7.org/fhir/ValueSet/benefit-term)

                                                      Coverage unit - annual, lifetime.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed for the understanding of the benefits.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      904. ExplanationOfBenefit.benefitBalance.financial
                                                      Definition

                                                      Benefits Used to date.

                                                      ShortBenefit Summary
                                                      Control0..*
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      906. ExplanationOfBenefit.benefitBalance.financial.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      908. ExplanationOfBenefit.benefitBalance.financial.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      910. ExplanationOfBenefit.benefitBalance.financial.modifierExtension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      912. ExplanationOfBenefit.benefitBalance.financial.type
                                                      Definition

                                                      Classification of benefit being provided.

                                                      ShortBenefit classification
                                                      Comments

                                                      For example: deductible, visits, benefit amount.

                                                      Control1..1
                                                      BindingFor example codes, see BenefitTypeCodes
                                                      (example to http://hl7.org/fhir/ValueSet/benefit-type)

                                                      Deductable, visits, co-pay, etc.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to convey the nature of the benefit.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      914. ExplanationOfBenefit.benefitBalance.financial.allowed[x]
                                                      Definition

                                                      The quantity of the benefit which is permitted under the coverage.

                                                      ShortBenefits allowed
                                                      Control0..1
                                                      TypeChoice of: unsignedInt, string, Money
                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to convey the benefits offered under the coverage.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      916. ExplanationOfBenefit.benefitBalance.financial.used[x]
                                                      Definition

                                                      The quantity of the benefit which have been consumed to date.

                                                      ShortBenefits used
                                                      Control0..1
                                                      TypeChoice of: unsignedInt, Money
                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Requirements

                                                      Needed to convey the benefits consumed to date.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))